No abstract

No abstract

A 32-year-old previously healthy man presented with headache that progressively worsened during the day. He denied any previous history of headache and trauma. There was no family history of neurological diseases. Examination revealed nuchal rigidity. Cranial computed tomography disclosed a left frontal hemorrhage. Brain magnetic resonance imaging revealed multiple cerebral cavernous malformations (CCM). The patient received conservative treatment. Cerebral cav-ernous malformations are commonly described in the famil-ial form and are frequently asymptomatic. When symptoms do occur, seizures are the most common followed by focal deficits and headache 1. Several mutations in CCM genes have already been identified in patients with sporadic disease 2. Figure 1. Axial cranial CT scan: an oval-shaped hyperdense lesion in the left frontal lobe with perilesional vasogenic edema and a small focus of blood in the contralateral frontal lobe. Figure 2. Brain MRI in axial T1 (A), Axial-susceptibility-weighted (B) and multiplanar reconstruction (C) showing an heterogeneous lesion with a hyperintense signal associated with perilesional vasogenic edema suggestive of acute hematoma. Additionally, there are multiple nodules with hypointense signal throughout the parenchyma and a subarachnoid hemorrhage in the left Sylvian fissure.

Thirty-eight cases of symptomatic cerebral aneurysms or spontaneous subarachnoid hemorrhage in children and adolescents were observed from 1965 to 1984; 33 cases were treated from 1970 to date. This group represents 2.6% of the total number of patients with subarachnoid hemorrhage treated at our institute in the same period. The cause of subarachnoid hemorrhage was unknown in 7 cases; an intracranial aneurysm had ruptured in 29 cases, and was unruptured but symptomatic in 2 remaining cases. Three aneurysms were mycotic. The most frequent aneurysmal locations were the internal carotid bifurcation and the anterior communicating artery; peripheral branches of the middle cerebral artery were also a relatively common location. Four patients were 3 years of age or younger: each presented peculiar clinical features, and 3 of the 4 had middle cerebral artery aneurysms. The remaining 34 patients were all above 9 years of age. Two groups were identified: (a) in 14 patients between 10 and 15 years of age, the aneurysm was most commonly at the internal carotid bifurcation (37%), and an intracerebral hematoma was observed in 50% of these cases; (b) in 20 patients between 16 and 20 years of age, the most common aneurysmal location was the anterior communicating artery (35%), and intracerebral hematomas were rare (10% of cases). Among patients with aneurysms, 19 underwent surgical exclusion by clip, with 10% morbidity and 5% mortality; 5 patients in moribund conditions were not operated on; 5 patients were conservatively treated; in 2 patients the aneurysm had disappeared at a second angiography.(ABSTRACT TRUNCATED AT 250 WORDS)

No abstract