Headache Medicine 2020, 11(4):95-97 ISSN 2178-7468, e-ISSN 2763-6178
95
ASAA
DOI: 10.48208/HeadacheMed.2020.27
Headache Medicine
© Copyright 2020
Case Report
Frontal brain cavernoma in a 14-year-old boy: differential diagnosis
of secondary headache
Eduardo de Almeida Guimarães Nogueira , Marcos Vinicius de Queiroz, Philipe Rachas Saccab,
Marcelo Motta Zanatelli
Portuguese Society of Benecence of Santos, Clinical Medicine, Santos, São Paulo, Brazil
Abstract
Cavernoma consists of a rare type of vascular anomaly that can present with different neurolo-
gical manifestations. This article reports a case of cavernoma in a 14-year-old boy, whose rst
symptom was headache
Eduardo de Almeida Guimarães
Nogueira
eduagn@hotmail.com
Edited by
Mario Fernando Prieto Peres
Keywords:
Headache
Cerebral Hemorrhage
Frontal Lobe
Received: September 20, 2020
Accepted: November 30, 2020
96
ASAA
Nogueira EAG, Queiroz MV, Saccab PR, Zanatelli M
Frontal brain cavernoma in a 14-year-old boy: differential diagnosis of secondary headache
Introduction
C
avernoma is a rare type of vascular anomaly¹ char-
acterized by constituting a space lacking in the brain
parenchyma, lled mainly by dilated sinusoidal veinsIt
affects mostly males in the third decade of life and is divided
into sporadic or familial.³ The aim of this article is to report a
case of cavernoma in a young patient and draw attention to
this pathological entity as a cause of secondary headache.
Material and Methods
The data contained in this report were obtained through in-
terview with the patient and his family members, and review
of the medical record.
Case Report
A 14-year-old male patient was brought to the emergency
room on the morning of Nov. 11th, 2020, with a complaint
of frontal shooting headache, fever (38°C), and an episode
of vomiting preceded by nausea the night before.
The patient was previously healthy, was not taking any med-
ication continuously, and had never undergone any surgical
procedures. The mother reported that during intrauterine life,
the patient developed only one umbilical artery, and that he
was followed by a neurosurgeon during the rst four years
of life, due to an above average brain girth. As he never
manifested any neurological symptoms, he was discharged.
She also informed that her son had suffered two head traumas
throughout his life, both in the frontal region of the skull, the
last one three years prior to the report. Both accidents did
not cause major repercussions.
Figure 1. Entry CT scan showing right frontal cavernoma.
The physician on duty requested a complete blood count and
urine test, both within normal limits. Besides the laboratory
tests, the patient had a chest X-ray and a CT scan of the
skull without contrast. The X-ray showed no changes, but
the CT scan showed a rounded, heterogeneous lesion with
well-dened contours in the right frontal lobe, compressing
the ventricle and deviating the midline.
The patient was evaluated by the neurosurgery team, which
suggested the possibility of a vascular malformation and
advised that a magnetic resonance imaging of the brain be
performed. The patient was sent to the intensive care unit
(ICU) with a prescription for intravenous corticosteroids and
prophylactic intravenous phenytoin.
He was admitted to the ICU asymptomatic, with a completely
normal neurological examination without any focal decits,
speech, or ocular changes.
Magnetic resonance imaging (MRI) of the brain was per-
formed and revealed a recent hemorrhagic lesion with slight
contrast enhancement with mild deviation of midline structures
and compression of the frontal horns of the lateral ventricles,
more accentuated on the right, measuring 2.6 x 3.5 x 2.7 cm,
conrming the hypothesis of cerebral cavernoma.
The patient underwent surgery with no major intercurrences
and was released 72 hours later after a control CT scan was
performed.
Discussion
Cryptic hemangiomas or cerebral hamartomas, also called
cavernomas are lesions easily visualized on CT scans due
to their hyperdense nodular formation. The most common
symptoms reported are epileptic seizures, headache, and
dizziness.
4
Vaquero et al.³ reported 16 cases of brain cavernomas, with
50% presenting with seizures, 37.5% manifesting focal symp-
toms and 12.5% intracerebral hemorrhages. The frontal lobe
was the second site with the highest incidence of hamartoma
(25%), second only to the parietal lobe (31%). The exam of
choice for the diagnosis of cavernoma is magnetic resonance
imaging of the brain. Since most of the time the anomaly is not
connected to adjacent arteries, angiography is unnecessary.
In 1994, Zabramski et al.
5
created a classication that groups
cavernomas into groups I through IV according to their ap-
pearance on MRI.
4
The most encountered type is II, also called
"popcorn" lesion due to the heterogeneous appearance, since
in many cases, the nodulation is surrounded by a hyperintense
halo due to the presence of hemorrhage.¹