title: Propranolol stops progressive multiple cerebral cavernoma in an adult patient.
abstract: OBJECTIVE
  To report a case of a patient with multiple cerebral cavernous malformations (CCM).
  
  
  METHODS
  A 22year old man with mild von Willebrand disease presented with two occipital CCM, one of them with acute hemorrhage. Genetic testing for CCM1-3 did not reveal a mutation. Over a period of 54months, the patient suffered 26 new CCM hemorrhages despite multiple treatment attempts including thalidomide, simvastatin and hemostatic factors. Only after initiation of propranolol, which has already been successfully used in three children with giant cerebral cavernoma, the occurrence of new CCM with hemorrhages was completely stopped already at dose of 30mg daily - now for a period of 26months and without any other medications.
  
  
  CONCLUSIONS
  This case suggests a protective role for propranolol in preventing the occurrence of new cerebral cavernoma with hemorrhages in adults with multiple CCM.
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Germany; Department of Neurology and Clinical Neurophysiology, Medical Center Esslingen, Academic Teaching Hospital of the University of Tübingen, Germany. Electronic address: m.reinhard@klinikum-esslingen.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Reinhard
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Schuchardt
authors.affiliation: Department of Neuroradiology, University Medical Center Freiburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Meckel
authors.affiliation: Department of Internal Medicine, University Medical Center Freiburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Heinz
authors.affiliation: Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Felbor
authors.affiliation: Department of Neurosurgery, University Medical Center Essen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
authors.affiliation: Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Geisen
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects; D018450:Disease Progression; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D011433:Propranolol / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018696:Neuroprotective Agents; D011433:Propranolol
keywords: Cerebral cavernoma; Hemophilia; Intracerebral hemorrhage; Propranolol; Thalidomide; Willebrand