When a Seizure Reveals More Than a Hemorrhage: When to Suspect Cerebral Cavernous Malformations.
- 1Department of Medicine, National Autonomous University of Mexico, Iztacala Faculty of Higher Studies, Tlalnepantla, MEX.
- 2Department of Neurosurgery, Instituto de Seguridad Social del Estado de México y Municipios (ISSEMYM), Regional Hospital Tlalnepantla, Tlalnepantla, MEX.
Abstract
Cerebral cavernous malformations (CCMs) are low-flow vascular malformations that may be asymptomatic or present with seizures, hemorrhage, headache, or focal neurological deficits. Most are sporadic and solitary, whereas familial CCMs are associated with multiple lesions and autosomal-dominant inheritance. Distinguishing between these forms is clinically relevant for long-term management. We present a 33-year-old woman who presented with generalized tonic-clonic seizures following sleep deprivation. Computed tomography (CT) initially suggested a left frontal intraparenchymal hemorrhage. Magnetic resonance imaging (MRI) subsequently revealed two left frontal Zabramski type II CCMs. Electroencephalography showed cortical dysfunction with paroxysmal activity and contralateral propagation. Antiseizure treatment with phenytoin was initiated and later supplemented with levetiracetam. The patient remained asymptomatic and was referred for tertiary evaluation. This case highlights the diagnostic limitations of CT and the importance of MRI for CCM characterization and detection of multiple lesions. The presence of two cavernomas and a potentially relevant family history raises suspicion for familial CCM, although these findings alone do not establish a hereditary diagnosis. Genetic evaluation and detailed family assessment should therefore be considered. Treatment should be individualized; conservative management is appropriate in selected stable patients, whereas microsurgery and stereotactic radiosurgery are reserved for specific clinical scenarios.
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BibTeX
@article{uribehernandez2026when,
title = {{When a Seizure Reveals More Than a Hemorrhage: When to Suspect Cerebral Cavernous Malformations.}},
author = {Fernando Uribe-Hernández and Jesus Reyes-Reyes},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117023},
url = {https://europepmc.org/article/MED/42953484},
note = {CC BY},
}
RIS
TY - JOUR
TI - When a Seizure Reveals More Than a Hemorrhage: When to Suspect Cerebral Cavernous Malformations.
AU - Fernando Uribe-Hernández
AU - Jesus Reyes-Reyes
PY - 2026
DA - 2026/09/27
JO - Cureus
DO - 10.7759/cureus.117023
UR - https://europepmc.org/article/MED/42953484
AB - Cerebral cavernous malformations (CCMs) are low-flow vascular malformations that may be asymptomatic or present with seizures, hemorrhage, headache, or focal neurological deficits. Most are sporadic and solitary, whereas familial CCMs are associated with multiple lesions and autosomal-dominant inheritance. Distinguishing between these forms is clinically relevant for long-term management. We present a 33-year-old woman who presented with generalized tonic-clonic seizures following sleep deprivation. Computed tomography (CT) initially suggested a left frontal intraparenchymal hemorrhage. Magnetic resonance imaging (MRI) subsequently revealed two left frontal Zabramski type II CCMs. Electroencephalography showed cortical dysfunction with paroxysmal activity and contralateral propagation. Antiseizure treatment with phenytoin was initiated and later supplemented with levetiracetam. The patient remained asymptomatic and was referred for tertiary evaluation. This case highlights the diagnostic limitations of CT and the importance of MRI for CCM characterization and detection of multiple lesions. The presence of two cavernomas and a potentially relevant family history raises suspicion for familial CCM, although these findings alone do not establish a hereditary diagnosis. Genetic evaluation and detailed family assessment should therefore be considered. Treatment should be individualized; conservative management is appropriate in selected stable patients, whereas microsurgery and stereotactic radiosurgery are reserved for specific clinical scenarios.
SN - 2168-8184
ER -