Cavernomas – Vascular Malformations

00:01 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.

00:19 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.

00:40 And, of course, these patients can also bleed in the cavernoma. They can have seizures.

00:45 They can have progressive neurologic defects. Hemorrhage I mentioned already. But about half of them have no symptoms.

00:54 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.

01:05 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 venous insufficiency.

01:25 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.

01:51 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.