cavernous angioma - surviveable?

[mlw03]

Hello surgical colleagues -

I'm a pathologist, and have a question stemming from an autopsy case of mine. To be clear, whatever I learn here is for my own knowledge only and will not in any way get into the autopsy report. Basically I'd like to know if a cavernous angioma of the cerebellum is a treatable lesion. The patient was a healthy, college-age girl who was found dead in her dorm. She had diffuse SAH at autopsy, concentrated in the posterior fossa. After fixation and sectioning of the brain, there was a 5 cm vascular malformation in the cerebellum that was diagnosed as a cavernous angioma by a neuropathologist after microscopic examination. The history suggests she may have ignored symptoms for about a day before she died. If she had gone into an ED complaining of a headache within the first few hours of symptoms, is this something that could have been treated? If so, how? Again, this discussion is only to improve my understanding of vascular malformations of the brain, and will not be documented in any form. Thank you for your thoughts on this lesion.

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[kitsunepixie]

If she had gone into an ED complaining of a headache within the first few hours of symptoms, is this something that could have been treated? If so, how?

Perhaps. She may have been able to be treated with an EVD or a decompressive craniectomy if she presented early enough. I think that she was one of those very unlucky cases that we never get to hear about but pathologists get to see--I remember my pathology instructor in med school who told us about all the patients who he had seen who had died freakishly in their sleep, like a kid who had a colloid cyst that caused acute obstructive hydrocephalus with herniation, or a young woman who woke up in the middle night exclaiming to her husband, "I feel like I'm dying!" only to die of massive hemothorax from a dissected pulmonary artery/ruptured emphysema bleb that turned out to be due to undiagnosed alpha-1-antitrypsin deficiency...*shudder*

I recommend www.uncleharvey.com for next time...more neurosurgeons watch that forum more than this.