radiologic procedure. But it avoids surgery
on the brain.
The cavernomas are less common. There’s
an angioma one that’s a little more evident
with tangled vessels. And then there’s a
haemangioma one which is more like the AV
malformation that we just looked at.
These also can do the same thing as the more
typical AV malformation – the connection
between artery and vein. Remember: in the
cavernoma the connection is not direct between
the artery and the vein but through a series
of very primitive tangled blood vessels.
And, of course, these patients can also bleed
in the cavernoma. They can have seizures.
They can have progressive neurologic defects.
Hemorrhage I mentioned already. But about
half of them have no symptoms.
And again, the diagnosis is just like with
the AV malformations. Particularly in the
brain it’s by CT scan, by MRI or by angiography.
The MRI has an interesting pattern of sort
of ‘salt and pepper’ appearance probably
because there’s constant little leaking
of blood from these abnormal primitive blood
vessels that leaves some of this hemosiderin
pigment that, remember, we talked about as
depositing in the skin in patients with chronic
And here we see a CT scan of a cavernoma.
And this is almost certainly a preoperative
or a pre-radiologic embolisation image. If
they’re going to be doing the radiologic
image, it will be including an angiogram because
they’re going to be looking for the blood
vessel that feeds this cavernoma so that they
can go up and embolise it with some material.
Sometimes the material is small metal spheres.
Sometimes it’s a special compound that clots
once it hits the blood and then destroys the
cavernoma. The same technique that you use
with an AV malformation in the brain.