Matthias Reinhard1, Florian Schuchardt2, Stephan Meckel3, Jürgen Heinz4, Ute Felbor5, Ulrich Sure6, Ulrich Geisen7. 1. Department of Neurology, University Medical Center Freiburg, Germany; Department of Neurology and Clinical Neurophysiology, Medical Center Esslingen, Academic Teaching Hospital of the University of Tübingen, Germany. Electronic address: m.reinhard@klinikum-esslingen.de. 2. Department of Neurology, University Medical Center Freiburg, Germany. 3. Department of Neuroradiology, University Medical Center Freiburg, Germany. 4. Department of Internal Medicine, University Medical Center Freiburg, Germany. 5. Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald, Germany. 6. Department of Neurosurgery, University Medical Center Essen, Germany. 7. Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Germany.
Abstract
OBJECTIVE: To report a case of a patient with multiple cerebral cavernous malformations (CCM). OBSERVATION: A 22year old man with mild von Willebrand disease presented with two occipital CCM, one of them with acute hemorrhage. Genetic testing for CCM1-3 did not reveal a mutation. Over a period of 54months, the patient suffered 26 new CCM hemorrhages despite multiple treatment attempts including thalidomide, simvastatin and hemostatic factors. Only after initiation of propranolol, which has already been successfully used in three children with giant cerebral cavernoma, the occurrence of new CCM with hemorrhages was completely stopped already at dose of 30mg daily - now for a period of 26months and without any other medications. CONCLUSION: This case suggests a protective role for propranolol in preventing the occurrence of new cerebral cavernoma with hemorrhages in adults with multiple CCM.
OBJECTIVE: To report a case of a patient with multiple cerebral cavernous malformations (CCM). OBSERVATION: A 22year old man with mild von Willebrand disease presented with two occipital CCM, one of them with acute hemorrhage. Genetic testing for CCM1-3 did not reveal a mutation. Over a period of 54months, the patient suffered 26 new CCM hemorrhages despite multiple treatment attempts including thalidomide, simvastatin and hemostatic factors. Only after initiation of propranolol, which has already been successfully used in three children with giant cerebral cavernoma, the occurrence of new CCM with hemorrhages was completely stopped already at dose of 30mg daily - now for a period of 26months and without any other medications. CONCLUSION: This case suggests a protective role for propranolol in preventing the occurrence of new cerebral cavernoma with hemorrhages in adults with multiple CCM.
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