Unilateral facial palsy in an infant: an unusual presentation of familial multiple cerebral cavernous malformation

Abstract

SummaryCerebral cavernous malformation (CCM) in infants tends to have genetic predisposition. These cavernomas have a progressive course of events and associated neurological symptoms with increase in age. They most commonly present with seizure and syndrome of increased intracranial pressure comprising of headache, vomiting and focal neurological signs. We describe a case of a 7-month-old infant who presented with an acute onset of right facial paralysis with a background of familial CCM. The CT and MRI scan revealed fresh haemorrhage in the right cerebellar and pontine cavernomas with surrounding oedema and no evidence of obstructive hydrocephalus. These two cavernomas re-bled in a week duration causing episodes of incessant crying and irritability. After discussing the pros and cons of treatment, owing to stable clinical status, the patient is currently been managed conservatively. BACKGROUND

Multiple cranial palsy in pasein with cerebral cavernoma malformations on the brain stem

“…Cerebral Cavernous Malformations are generally congenital lesions that occur at any age from the neonatal period to adulthood. Familial lesions are inherited in an autosomal dominant manner (Zakaria et al, 2012). The clinical symptoms usually include seizures (in 40-70% of patients), focal neurologic deficits (in 35-50% of patients), unspecified headaches (in 10-30% of patients), and cerebral hemorrhage (in 41% of patients).…”

Multifocal primary central nervous system angiosarcoma: illustrative case

“…Intracerebral angiosarcoma is highly hemorrhagic, often presenting with intracranial hemorrhaging. 2,[4][5][6][7]12,15 Consequently, patients are at risk of rebleeding and recurrence. 2,15 The tumor tends to present as a well-demarcated, heterogeneous, moderately to strongly enhancing lesion with vasogenic edema.…”

“…2,[4][5][6][7]12,15 Consequently, patients are at risk of rebleeding and recurrence. 2,15 The tumor tends to present as a well-demarcated, heterogeneous, moderately to strongly enhancing lesion with vasogenic edema. 4 Although few other cases have mentioned nodules, in our case, a nodule was found in the hematoma on enhanced T1-weighted imaging (Fig.…”

“…few prior case reports have revealed imaging findings indicative of nodules. 2,4,7,15 Follow-up MRI revealed multiple hemorrhagic nodules (Fig. 1D-F), which may have comprised the metastatic dissemination of the angiosarcoma.…”

“…There have been some reports of multiple metastatic intracranial angiosarcomas from other systemic organs. 12,15 These metastatic lesions are usually located deep in the brain lobe. 2,12 On one hand, hematogenous metastasis is considered to be the cause of metastatic angiosarcoma.…”