Cavernomas (also known as cavernous angiomas, cavernous haemangioma or cavernous hemangioma) are vascular malformations consisting of a tangle of vessels that resemble a blackberry. There is no intervening brain within its interstices.
Berry that resembles cavernoma
How common are cavernomas?
Approximately 1 in 200 people have a cavernoma.
How does a cavernoma develop?
Many are present at birth and in some of these cases there is a family link. The majority of patients diagnosed with cavernomas report no history of a family link. However, those with more than one cavernoma are suspected to be more likely to have an inherited factor. When the condition has been inherited approximately half of the family will have a cavernoma. Not all cavernomas are present at birth and in some cases they develop where the pressure where the brain has been subjected to high pressure within the veins (not your blood pressure) over prolonged periods of time. This can be due to blockage in veins of the brain (such as due to thrombosis of a brain vein) or an inefficient venous drainage system for a segment of brain that was present from birth the so-called anomalous venous drainage (sometimes called a venous angioma).
Who is at risk of having a cavernoma?
If there have been a number of family members diagnosed with a cavernoma then the risk for any one else in the family having a cavernoma is 50%. Often there is no definite family history but there might be a suggestion of a family history if a number of family members have had small strokes and/or epilepsy. In the absence of such a history (the majority of those with cavernomas), the condition is usually only diagnosed after a seizure (epileptic fit), a new loss of body function due to a bleed into the brain or an unsuspected finding when the MRI scan is performed for some other reason. Anyone may have a cavernoma and often there are no other health issues. It is common for cavernomas to be diagnosed in young adults. Both male and female are equally likely to have a cavernoma.
How are cavernomas diagnosed?
Typical MRI appearance of a bleed from cavernoma
An MRI of the brain is very accurate in making the diagnosis. Cavernomas produce images that allow differentiation from tumours (although occasionally I have found a tumour adjacent to a cavernoma) and thus, are rarely, a diagnostic problem. A typical cavernoma on MRI can be seen in the adjacent image.
Management of cavernomas
The managment options for cavernomas depends on whether they are located deeply within the brain (considered to be those occurring in the brainstem, cerebellar nuclei, thalamus and basal ganglia) or superficially. These are adressed on pages that can be accessed at the top of this page.