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(Stroke. 2008;39:3129.)
© 2008 American Heart Association, Inc.

Editorial

From Cavern-Dwellers to Cavernoma Science

Towards a New Philosophy of Cerebral Cavernous Malformations

Christian Stapf, MD Dominique Hervé, MD

From the "Centre de Référence des maladies Vasculaires rares du Cerveau et de l'il" (French Reference Center of Rare Vascular Diseases of the Brain and Eye, CERVCO), Department of Neurology, Hôpital Lariboisière, APHP, Paris, France.

Correspondence to Christian Stapf, MD, Department of Neurology, Hôpital Laribosière (APHP), 2, Rue Ambroise Paré, 75475 Paris cedex 10, France. E-mail christian.stapf@lrb.aphp.fr

Key Words: cerebral cavernous malformation • intracerebral hemorrhage • stroke • clinical trials

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 3222–3230.

Since the introduction of noninvasive imaging tools roughly 30 years ago, vascular malformations of the brain have attracted increasing interest. Among them, cerebral cavernous malformations (CCM) appear to be the most frequently diagnosed entity with current prevalence estimates ranging from 100 to 500 cases per 100000 in the general population.¹ They may come to clinical attention after epileptic seizures, progressive neurological syndromes, or symptomatic hemorrhage, but overall, asymptomatic lesions seem to be most frequently encountered since the introduction of highly sensitive gradient echo (T2*) weighted sequences in routine MR imaging protocols.²

Despite increasing detection rates and growing insight into underlying molecular and genetic mechanisms, many practical issues remain as yet unsolved, particularly when it comes to actual patient care and counseling:

First, no standardized imaging protocols exist. Brain MRI with the aforementioned T2*-weighted images are now considered the diagnostic standard, but the absence of contrast-enhanced T1 sequences may miss an associated developmental venous anomaly and vice versa, which may for example impact on the strategy of any neurosurgical intervention (Figure 1).

View larger version (73K):   Figure 1. Brain MRI study of a 37-year-old woman presenting with left internuclear ophtalmoplegia, ataxia, and a dissociated sensory deficit attributable to a left posterior pontine hematoma on FLAIR-weighted images (left plane). Three-month follow-up MRI shows a pontine developmental venous anomaly (DVA; gadolinium-enhanced T1, middle plane). Only the gradient echo sequence (T2*, right plane) reveals a cavernous malformation at the inferior left ponto-peduncular junction. The cavernoma, not the DVA, constitutes the . . . [Full Text of this Article]

Related Article:

Hemorrhage From Cavernous Malformations of the Brain: Definition and Reporting Standards

Rustam Al-Shahi Salman, Michel J. Berg, Leslie Morrison, Issam A. Awad on behalf of the Angioma Alliance Scientific Advisory Board
Stroke 2008 39: 3222-3230. [Abstract] [Full Text] [PDF]