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.