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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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My sister is a 35 year old extremely healthy and fit person.

Customer Question

Hello. My sister is a 35 year old extremely healthy and fit person. She recently suffered a seizure and after a cat scan it was determined she had some bleeding in the brain. An angiogram was performed and the source of the blood was not determined. Following
that an MRI was done resulting in a high suspicion of a vascular lesion or cavernoma in the temporal areaI believe was the term. A low suspicion of a tumor. An MRI was scheduled for two weeks in hopes of the blood being gone in order to get a clearer image.
My family is shaken by this news and are wondering if surgery is needed is it well tolerated? Also would a definitive tumor likely have showed on one of the other tests? Thank you
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Hello. Welcome to JA. I am a US trained board certified neurologist and will try to answer your question. Your sisters story does appear to follow the classic history for presentation of an cavernous hemangioma, also known as cavernoma presenting as a seizure disorder with localization to the temporal lobe. This lesion is a vascular lesion predominantly of low pressure venous cells, that can rupture and bleed. The blood itself, as it breaks down, is thought to irritate cortical neurons leading to the seizure. As it is low pressure, bleeding stops and resolution of the "bruise" on the brain is achieved over a few weeks. The blood products themselves can interfere with MRI imaging because of iron pigmentation in the blood, hence the delay which is the right thing to do. Isolation from other neoplasms or tumor types is made on the initial MRI by the absence of signs like "mass effect" or edema that tumors cause, or gadolinium (MRI contrast) enhancement if she received that. You can also do other MRI imaging sequences like MR Spectroscopy or proton weighted imaging, some of which were probably done to exclude tumor.

Treatment of cavernomas in young adults is a difficult area. To do surgery with its intrinsic risks or to just watch is the question. It is based on seizure frequency, etc. I can tell you from personal experience that I had a patient who was a male, a police detective, and wanted surgery because of the risk of recurrent seizure, it ruined his job. He had few symptoms and was seizure free after the initial event, but went on to successful surgery, though he stayed on his seizure medication as a precaution. It was a successful story Please get back to me with questions if I can help, or rate my service if satisfied. Dr Frank

Customer: replied 1 year ago.
In your opinion is a tumor unlikely due to her age and lack of risk factors? Also, no one has mentioned cancer even if the tumor is found.
She is still a bit confused and forgetful at times. It has only been 4 days. Is this due to the finding and or the seizure? She was fine before the seizure. She is being treated at Brigham & women's Boston
Expert:  Dr. Frank replied 1 year ago.

HI. If she is at Brigham, I can tell you that they are one of the best neurology programs in the country. The changes you note could be the result of the seizure, of the residual effect

of the bleeding as it changes and is reabsorbed. Blood itself as it contains iron can irritate brain, and cause "vasospasm" or changes in the blood vessels in the immediate area, reducing

blood flow to that area. This should pass within the first 2 weeks. So I would not be too anxious about that. The EEG is helpful to look at brain function as a result of the hemorrhage, so you might ask them about the eeg, if it has been repeated. Please get back to me with questions if I can help. Dr Frank

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