Spontaneous regression of an orbital intraconal cerebral cavernous malformation

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.

 

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Publication History

Article published online:
19 April 2024