Refractory status epilepticus during pregnancy secondary to cavernous angioma

Aladdin, Yasser; Gross, Donald

doi:10.1111/j.1528-1167.2008.01639.x

Cited by 19 publications

(10 citation statements)

References 13 publications

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“…Increased venous pressure and hormonal changes have been suggested as temporary factors during pregnancy. 1,9 With regard to local factors, we can potentially draw some conclusions from the reported cavernomas developing after radiation. 1,10,15 For example, chronic ischemia induced by radiation or other causes could be a local cofactor.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients

Steiger¹,

Turowski

Hänggi³

2010

FOC

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Object In this study, the authors present a review of a series of 20 intramedullary spinal cord cavernous malformations (SCCMs) with particular focus on MR imaging and prognostic factors. Methods Between 1994 and 2009, 20 patients with SCCM were treated under the care of the senior author. The diagnosis was made in all patients after the onset of clinical symptoms. The age of the 9 men and 11 women ranged between 26 and 71 years (median 38.5 years). The duration of symptoms prior to referral ranged from 1 week to 9 years (median 6.5 months). At the time of referral, 4 patients had no significant neurological deficits, 10 patients suffered significant functional restrictions, and 6 patients presented with severe paraparesis and loss of functional strength. None of the patients had complete paraplegia. Seventeen patients underwent microsurgical removal, while 3 patients opted for conservative therapy. For the present analysis, the medical records and MR images and/or reports were reviewed. Classification of length of history, pretreatment status, MR imaging pattern, and treatment modality was done and correlated with outcome. Results The cavernoma was located at the cervical level in 8 patients and between T-1 and L-1 in 12 patients. The cavernoma appeared as mainly T2 hyperintense on MR images in 7 patients, mainly T2 hypointense in 2 patients, and mixed in the remaining 10 patients. The craniocaudal extension of the core varied between 5 and 45 mm. In 2 patients with cervical cavernomas, a distinct T2 signal of the spinal cord cranial and distal to the cavernoma was seen, and in a patient with a large thoracic cavernoma, T2 extinction cranial and caudal to the cavernoma was seen as a sign of hemosiderosis. Neurological deficits improved postoperatively in 12 of the surgically treated patients, remained stable in 2, and deteriorated in 3. The 3 patients who were conservatively treated remained stable over a follow-up of 3–9 years. Postoperative improvement was seen in 5 of 7 surgical patients with a history of symptoms of 2 months or less, 5 of 6 patients with a history of 2–24 months, and in 2 of 4 patients with a history of more than 2 years. Two of the 3 patients with postoperative deterioration had a history of more than 2 years and the third a short history of 1 month. Conclusions Although a satisfactory outcome can be achieved through surgical treatment of SCCMs, some patients worsen after surgery or during the postoperative course. Long-term stability is possible in oligosymptomatic conservatively treated patients. The prevalence and pathophysiological importance of segmental spinal cord edema and hemosiderosis is incompletely understood at the present time.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients

Steiger¹,

Turowski

Hänggi³

2010

FOC

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“…Ultimately, counting references gleaned from other sources, 1339 abstract entries were reviewed (many were repeated). Despite this number and counting the current report, only 26 cases across 16 references were identified [3,4,7,13,17,[27][28][29]31,[33][34][35][36][38][39][40], in whom a patient clearly identified as pregnant was deemed to have the acute onset of symptoms related to a CM involving the brainstem. These references and cases are listed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…In one woman whose infant was stillborn, a CM was found in the umbilical cord [26]. With respect to CNS lesions, presenting symptoms during pregnancy largely have been seizures [2][3][4]11,13,27], headaches [28,29], and/or rapid onset neurological deficits with or without hemorrhage from the CM [3,4,11,13,17,30,31]. According to one review, published in 2006, virtually all previously-reported CNS cases in pregnancy have involved either supratentorial or spinal lesions [31], though brainstem lesions have been reported in non-pregnant women [3,4,9,13,30].…”

Section: Introductionmentioning

confidence: 99%

Cavernous hemangioma presenting during pregnancy: A detailed literature review

et al. 2015

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Cavernous hemangiomas (CH) are occult vascular malformations, typically presenting as hemorrhage within a cerebral hemisphere, or as seizures. Brainstem and cerebellar locations of these lesions are less commonly described. Potentially very serious, they tend to result in severe deficits or death. We review the existing scientific literature on their presentation and course during pregnancy. Relevant cases were identified through electronic searches of multiple internet search databases, including PubMed, SciSearch, Scientific Commons, Springer Link, and Google, using advanced search functions and multiple search terms, using both American and British spellings. Detailed literature review revealed, including our own single case, 26 patients, ranging from 15 to 37 years, with 28 episodes of CH presenting during pregnancy. Two thirds occurred in the third trimester. Supratentorial lesions all presented with seizures, but without neurological deficits or documented hemorrhage, and all patients did well. Conversely, infratentorial lesions always presented with neurological deficits, usually with hemorrhage and never with seizures, and outcomes were quite variable, including maternal and fetal deaths. CHs are rare in pregnancy, but can affect pregnant women of any age, tending to occur in the 3rd trimester. Supratentorial CH present with seizures and patients generally do well. CH within the brainstem present with hemorrhage, and such patients have a guarded prognosis. If far enough into gestation, immediate delivery of the fetus and resection of the lesion are recommended.

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“…Thirty CCM cases and 4 spinal intramedullary cavernous malformations (SICM) in pregnant patients were found during a thorough literature search. 11,[14][15][16] With regards to brainstem CMs, 12 cases during pregnancy were described in literature thereof only 2 cases were operated before delivery. 8,[12][13][14] All other CCM cases were treated conservatively until delivery and indication for surgery was then reassessed, 2 of the 4 SICM cases were treated microsurgically during pregnancy.…”

Section: B) Analysis Of Current Literaturementioning

confidence: 99%

Neurosurgical considerations on highly eloquent brainstem cavernomas during pregnancy

Burkhardt

Bozinov

Nürnberg

et al. 2012

Clinical Neurology and Neurosurgery

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OBJECTIVE: Cerebral cavernous malformations (CCMs) and especially cavernous malformations (CMs) in highly eloquent brain areas such as brainstem CMs are rare but possible events during pregnancy. Due to the few published cases in literature clear recommendations regarding the management are rare. In this study we evaluate the proceeding decision in pregnant patients with highly eloquent brainstem CMs. METHODS: In our series 43 patients with CMs in highly eloquent brain areas, including 39 patients with brainstem CMs, were surgically treated by the senior author between July 2007 and July 2010. Out of these, 29 patients were female and three of them presented with a symptomatic brainstem CMs during pregnancy and were included in this study. According to our experiences and to the available literature we analyzed demographic and clinical variables to provide recommendations for the management of pregnant patients with highly eloquent brainstem CMs. RESULTS: Only one patient was operated during pregnancy the other two patients were surgically treated after delivery, respectively. A thorough review of the literature revealed 12 patients with brainstem cavernomas during pregnancy there of only two patients were operated during pregnancy. CONCLUSION: Surgical treatment during pregnancy is rarely required, but needs to be performed right away in life-threatening and rapidly progressive clinical situations. Pregnant women with CMs in highly eloquent brain areas such as brainstem CMs need to be treated in specialized centers to assess the best point of time for surgery. Our study offers a useful tool to support the proceeding decision in this rare but important situation. AbstractBackground Cerebral cavernous malformations (CCMs) and especially highly eloquent cavernous

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Refractory status epilepticus during pregnancy secondary to cavernous angioma

Cited by 19 publications

References 13 publications

Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients

Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients

Cavernous hemangioma presenting during pregnancy: A detailed literature review

Neurosurgical considerations on highly eloquent brainstem cavernomas during pregnancy

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