Cavernous Malformation Found in Patient With Subarachnoid Hemorrhage

Neurosurgery on a 58-year-old man who presented with acute onset of severe headache and vomiting, and whose condition worsened during his hospital stay, revealed a subarachnoid hemorrhage caused by a cerebral cavernous malformation. The unusual presentation and discovery were detailed in a case report published online in Cureus.

“This report highlights the importance of considering cavernous malformations in the differential diagnoses of subarachnoid hemorrhage, especially in the absence of informative results from computed tomography angiography and digital subtraction angiography studies,” wrote corresponding author Fatima Al Sada, MD, resident physician in neurological surgery at Hamad Medical Corporation in Doha, Qatar, and coauthors. The otherwise healthy patient presented to the emergency department with a 2-day history of an acute-onset severe holocephalic headache and associated vomiting. A computed tomography (CT) scan showed subarachnoid hemorrhage, but subsequent CT angiography and digital subtraction angiography studies showed no evidence of vascular abnormalities, according to the report.

The patient was admitted to the surgical intensive care unit for supportive management. Early in the stay, however, his condition deteriorated. After an emergency CT scan showed further expansion of the hemorrhage, the patient received a craniotomy. During the operation, surgeons found an incidental mass in the patient’s temporal lobe. Histopathological examination confirmed cavernoma, which the authors believe was the underlying cause of the subarachnoid hemorrhage.

After surgery, the patient remained in critical condition, and his condition worsened again about a week later. He died 12 days after surgery. “Despite the rare occurrence of subarachnoid hemorrhage secondary to cavernous malformations, it remains a possibility that carries serious and potentially fatal health consequences,” the authors wrote. “Therefore, cavernous malformations and other angiographically occult vascular lesions should certainly be considered in the differential diagnoses of subarachnoid hemorrhage.”

Reference

Al Sada F, Khan M, Iqbal J, Mohammed K, Ayyad A. subarachnoid hemorrhage caused by supratentorial cerebral cavernous malformation: a case report. Cureus. 16(1):e51597. doi:10.7759/cureus.51597