Discussion
Cavernoma is a benign low flow vascular malformation with an unknown
etiology. However, it has been linked to cranial radiation, coexisting
vascular malformations, genetic and hormonal variables, and other
causes.[4] The majority of cavernoma is supratentorial in
location, but it can also be found in spinal cord as well as the extra
axial region. Most of the cases of cavernoma are asymptomatic and
detected on autopsy incidentally. [5] In patients with
cerebral cavernous malformations (CCMs), epileptic seizures are the most
prevalent symptom. It has been suggested that repeated microhemorrhages
and hemosiderin deposits in the surrounding cortical tissue lead to
hyperexcitability because iron ions produce free radicals and lipid
peroxides. [6]
Cavernomas are angiographically concealed malformations; thus, the
identification of cavernomas is more challenging than that of other
vascular disorders. Some of the cutting-edge methods utilized for the
diagnosis of CMs include conventional T1- and T2-weighted MR imaging,
gradient echo sequences, high-field MRI, susceptibility-weighted
imaging, diffusion tensor imaging, and functional MRI.[7]In our case, CT findings were insignificant, and cavernoma was diagnosed
on an MRI of the brain.
Antiepileptic medications are preferred as a first line of treatment in
CCM patients who have had a single episode rather than immediately doing
surgery, and antiepileptic medications were found to be 47–60%
effective in controlling newly diagnosed cavernoma-related epilepsy. So,
routine follow-up with a neurologist is advised. Early surgery should be
taken into account for patients who have a significant risk of bleeding,
who are unable to adhere to AED therapy, and who have a strong desire to
finally cease using AEDs.[8] Our patient responded with
anti-epileptic drugs.
A similar case with seizures and migraine-like headaches was described
in a case report published in 2017 by Chirchiglia D et. al. We hereby
present the rare case of small frontal lobe cavernoma presented with
complex focal seizures and migraine like headaches that are effectively
controlled with antiepileptic medications.