1447 - Rupture of congenital cavernomas leading to hemorrhagic stroke: a Case Report

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

NS

Navjot Singh, MD

Resident Physician
NYU Langone
Long Island City, New Jersey, United States

Co-Author(s)

AD

Amritjot Dhillon, BS

medical student
Touro University
New York, New York, United States

Corresponding Author(s)

PA

Prin Amorapanth, MD, PhD

attending physician, rehabilitation
NYU Langone
new york, New York, United States

Case Diagnosis: Rupture of congenital cavernomas leading to hemorrhagic stroke

Case Description: 19 y.o. male with no prior medical history who presented on 4/20/2023 with several days of right sided numbness followed by binocular diplopia found to have left pontine and left cerebellar hemorrhages, with subsequent expansion of cerebellar hemorrhage, s/p left suboccipital craniectomy and EVD placement. He has improved remarkably since then with minimal deficits. His catheter angiogram was unremarkable and his follow up MRI brain 4 months supported cerebral cavernomas as underlying source of hemorrhages. No clear precipitant identified to explain the rupture of these cavernomas, which may have been congenital, despite thorough workup. Patient was found to have low vWF levels and is to follow up with hematology.

Discussions: This rare case highlights the unfortunate rupture of congenital cavernomas leading to stroke in a pediatric patient. Most cases of cavernomas are due to congenital malformation and can occur anywhere in the body but tend to cause serious issues when present in the brain and spinal cord. Symptoms may include severe headaches, seizures, weakness in arms or legs, paresthesia, aphasia, vision changes, and issues with memory and gait. The most concerning complication of recurrent hemorrhaging cerebral cavernomas is the development of a hemorrhagic stroke and subsequent neurological damage, as in this case.

Conclusions: This case highlights the significance of a multi-faceted approach to appropriate physiatric care for a patient with a complex clinical picture. It is notable how well of a functional recovery the patient made with timely and appropriate physiatric care specifically addressing the patient’s deficits as a whole. The patient was provided with resources by neuropsychology, progressed appropriately with PT/OT, and had autonomic dysfunction leading to tachycardia well controlled with propranolol. A holistic physiatric approach in rare and vulnerable pediatric patients is pivotal to achieving lasting functional gains in such cases.