Cerebral cavernous malformations (CCM) are also called angioma, cavernous angioma, and cavernous hemangioma. They are developmental vascular malformations - not a neoplasm - consisting of variably sized sinusoidal spaces closely grouped and without intervening brain tissue. Often described as a "blood sponge". They are associated with developmental venous anomaly (DVA) and may develop after radiation therapy.

Presentation: Incidental or with Seizures

Inheritence: May be sporadic or autosomal dominant (KRIT1 gene)

Location: subcortical; often asymptomatic, but may present with seizures and rarely with hemorrhage.

Previously considered as the rarest form of vascular malformation because they are usually "invisible" on angiography. However, they are more frequently seen on MR and CT - often as unsuspected and asymptomatic (incidental) findings.

Approximately 30% will calcify.

Angiography may be unremarkable, or may rarely show an abnormal capillary blush. They are slow flow lesions, without shunting, and they do not cause enlargement of the feeding arteries. Watch for associated DVA malformation.

CT may show partially calcified mass, typically without mass effect or edema, and homogenous enhancement of the non-thrombosed paten portions.

MR demonstrates mixed signal intensity on T1 and T2 (subacute blood), and a hypointense rim (hemosiderin).

NOTE: Multiple CCM indicate the autosomal dominant heritable form and first-degree relatives should be evaluated.