A blood vessel in the brain? Let's learn about Cavernous Malformation (Cavernoma) in simple terms

Do you sometimes get headaches for no reason? Or have you suddenly had a seizure? Maybe your doctor said during a brain scan that you have a small blood clot in your brain? It's normal to feel a little scared and worried when you hear something like this. But don't worry. Most of the time, this is not serious. Today we are talking about this 'brain clot' or medically called `Cavernous Malformation`. Let's talk about this simply, in a way that you can understand.

What is Cavernous Malformation?

Simply put, a `Cavernous Malformation` is an abnormal lump formed by the tiny blood vessels in our body, called capillaries, becoming tangled together. It looks like a raspberry at first glance. Inside this lump are many small cavities filled with blood.

Think about it, our normal blood vessels are made up of strong walls. But the walls of the blood vessels in this `Cavernous Malformation` are very thin and weak . And they don't have proper support. This is where the problem starts. Because of these weak walls, sometimes there is a high chance that some blood will leak out of these veins into the surrounding tissues.

This condition is most commonly seen in our brain and spinal cord . That is why it is also called `Cerebral Cavernous Malformation`. However, it can occasionally develop in places like the skin, liver, and eyes.

Doctors call this condition by different names. So don't worry if you see one of these names in your report, they all mean the same thing.

• Cavernomas
• Cavernous Hemangiomas
• Cerebral Cavernous Malformations
• Cavernous Angiomas

Are these Cavernous Malformations really dangerous?

The biggest question that many people have when they hear this name is, "Is this cancer? Is this dangerous?" First of all, it's not cancer .

But whether this condition is dangerous or not varies from person to person. It depends on several factors:

• Size of the lump: How big it is.
• Number of lumps: How many lumps like this are there in your body.
• Location: Where in the brain is it located?
• Risk of bleeding: There is a chance that it will burst and cause a major hemorrhage.

Because the walls of these blood vessels are thin, there is a risk of bleeding. Bleeding inside the brain can cause conditions such as seizures, paralysis, or stroke. If the bleeding is severe, it can be life-threatening.

Therefore, to know exactly what your situation is, it's best to talk openly with your doctor. He or she will review your scan report and explain the risks associated with your condition.

What are the symptoms of this condition?

Most people with this condition do not have any symptoms. But if they do, it is often a sign that a small amount of blood is leaking from the blood vessel. These symptoms usually begin to appear between the ages of 20 and 60.

The table below lists some of the most common symptoms.

What is the reason for this situation?

Most of the time, that is, in about 80% of cases, doctors do not know the exact cause of these `Cavernous Malformations`. They occur `sporadically`.

But in about 20% of cases, it has a genetic link . This means that the condition can be passed down from generation to generation. Three genes have been identified that cause it:

• `CCM1 (KRIT1)`
• `CCM2`
• `CCM3 (PDCD10)`

Simply put, these genes are what make the proteins that help connect the cells in our blood vessels and keep them strong. When there is a defect or variation in these genes, the connections between those cells become weak. That's when these abnormal, weak blood vessel clots form.

This condition is inherited in an ``Autosomal Dominant`` pattern. This means that a child can have this condition whether they inherit one of the defective genes from either the mother or the father. If you have this genetic condition, there is a 50% chance that your child will inherit it. If someone in your family has this condition or if someone has more than one of these genes, it is more likely to be due to a genetic cause.

How does a doctor diagnose this?

Often, this condition is diagnosed incidentally during a brain scan for another reason, such as a headache or an accident, or after symptoms such as seizures appear.

The main test used to diagnose this is an MRI (Magnetic Resonance Imaging) scan .

• Regular MRI: This can clearly see things like the location and size of the lump.
• Special MRI (Susceptibility-Weighted Imaging): This is an even more sensitive scan. It can detect very small clots, as well as traces of very small previous bleeding. This information can help your doctor get an idea of ​​your future risk.

Additionally, a genetic test can be done to look at family history and, if necessary, determine if it is a genetic condition.

What are the treatments available?

Not everyone who is diagnosed with a cavernous malformation will need surgery. Treatment depends on your symptoms, the location of the lump, and whether it is bleeding.

1. Monitoring

If you have no symptoms and are not bleeding from the lump, your doctor will often follow a "watchful waiting" approach.

• MRI scans at regular intervals : Scans are performed about once a year to check for changes in the size of the tumor and new bleeding.
• Awareness of symptoms: You will be informed about what symptoms to be concerned about and when to notify a doctor immediately.

2. Symptom control with medication

If you have symptoms like seizures or headaches due to the lump, your doctor will prescribe medication to control those symptoms. These medications won't make the lump go away, but they can help control the discomfort it causes.

3. Surgical Removal

Surgery is only recommended in certain special cases.

• If you have had more than one bleed with symptoms .
• If the bleeding has caused neurological impairment (e.g., loss of sensation on one side of the body, changes in vision) and the condition is getting worse day by day.
• If you have a seizure that cannot be controlled with medication.
• If the tumor is located in a place where it can be safely removed without causing significant damage to the brain.

The decision to have surgery or not is made by a neurosurgeon after a lengthy discussion with you about the pros and cons of the surgery.

What can I do to reduce the risk of bleeding?

While there's no way to prevent these lumps from forming, there are a few things you can do to reduce the risk of them bleeding or bursting. That means taking good care of your overall health.

• Maintain healthy blood pressure, cholesterol, and blood sugar levels .
• If you are currently taking any medications, such as blood thinners , talk to your doctor about whether they could affect this condition.
• Exercise for at least 30 minutes most days of the week.
• Completely avoid the use of tobacco products (smoking) .
• Meet with the doctor at the scheduled time for a check-up and ask if you have any questions or concerns.

When should I go to ETU soon?

This is very important. If you know you have a `Cavernous Malformation`, and the following symptoms suddenly appear, do not waste time and immediately go to the Emergency Treatment Unit (ETU) of the nearest hospital .

These could be signs of bleeding in the brain, which can lead to a stroke, so it's important to seek treatment quickly.

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