Introduction Cerebral Cavernous malformations are benign vascular malformations, which can occur
in any area of the human brain. Clinical manifestations include seizures, intracranial
hemorrhage and different focal neurological deficits. Symptomatic CCMs and location
in the brainstem are indications for the necessity of treatment.
Case description A 80-year-old female patient was admitted with acute double vision and retrobulbar
pain of the left eye. The neurological examination showed no abnormalities. Cardiac
function was examined diagnosing an atrial fibrillation. A therapy with bisoprolol
was started. Imaging revealed a retrobulbar mass with contact to the ethmoid sinus.
Initial evaluation suggested the mass to be a CCM. The patient, having no more symptoms
three days after the initial symptom onset, did not consent to surgical treatment
options. The colleagues from the department of neuroradiology suggested a wait and
scan approach for the time being. After 4 weeks the MRI showed a nearly complete regression
of the orbital mass.
Discussion The size of CCMs can vary over time due to hemorrhage and hemorrhage resolution.
But usually the size increases over longer periods of time. Spontaneous size reduction
up to the point of almost disappearing completely has not been described yet. It should
be discussed, if the initiated beta-blocker therapy could have impacted the CCM in
the same way atenolol reduces infantile hemangioma. The initial propranolol dose for
infantile hemangioma patients is significantly higher than the. administered Bisoprolol
dose in our patient questioning, if it really could have had an effect. But contrary
to atenolol, bisoprolol is a moderately lipophilic beta blocker, enabling it to pass
the blood brain barrier.
