What is a cavernoma?
What is a cavernoma?A cavernoma (also called cavernous hemangioma) is a vascular malformation consisting of small vessels, tangle, and sometimes calcifications and connective tissue. This can occur in the brain and in the spinal cord.
How common is a cavernoma?Cavernomas are rare (found in less than 0.2% of the population) and are as common among men as among women. Usually there is one cavernoma, but in some patients there are several cavernomas.
SymptomsThe first symptoms usually occur between the age of 20 and 40. Small hemorrhages may cause epileptic seizures or loss of function. The location of the small hemorrhages determines which symptoms of loss of functions occur. Large hemorrhages can lead to an acute life-threatening situation. This is rare in cavernomas.
Tests and diagnosisA cavernoma cannot be made clearly visible by means of a contrast examination of the vessels (angiography). This is why it is also called "occult" (non-visible) vascular malformation. Sometimes a CT scan shows the calcifications in a cavernoma, which leads to the suspicion of a cavernoma. The diagnosis can only be made once an MRI scan has been made. The MRI scan is the only test that gives a good picture.
Life with a cavernoma
When a cavernoma is being diagnosed, there is often uncertainty about activities that increase the pressure on the head. Examples include flying, diving, going on a roller coaster, pushing, going to the sauna, or having sex. There are no indications that these activities increase the risk of having a hemorrhage from a cavernoma. These activities can therefore be carried out as usual.
A cavernoma in the brain may increase the risk of symptoms or hemorrhaging during pregnancy. If you want to have a child, it is advisable to discuss with your doctor whether this is a reason to treat the cavernoma.
A cavernoma in the brain is generally not hereditary, but is more common in hereditary syndromes, such as von Hippel-Lindau.
There are legal requirements for the suitability of driving motor vehicles according to the “requirements for fitness to drive” regulation of the health inspection. The CBR (Dutch Central Driving License Office) supervises compliance with this requirement.
If you have a cavernoma without symptoms, that has not hemorrhaged, there are no restrictions on the use of motor vehicles.
If the symptoms of the cavernoma affect your ability to drive, your specialist will need to make a report about it. On the basis of this report, the Dutch central driver licensing office (CBR) can decide whether an additional independent medical examination or a driving test is required. Your medical specialist will write the report in addition to the CBR's declaration of health (website in Dutch).
In the case of epilepsy as a result of a cavernoma, you can be declared fit to drive for a certain period of time after the end of a seizure-free period. The duration of the seizure-free period depends on several factors. Discuss with your specialist what applies to you.
A cavernoma hemorrhage
These hemorrhages usually occur in the brain tissue (intracerebral hemorrhage). Hemorrhages resulting from a cavernoma is most common in people between 20 and 40 years of age.
Hospitalization after hemorrhage from a cavernoma
This can be done at home, at a rehabilitation center, or in a recovery ward in a nursing home. Depending on your problems, you will be accompanied by physiotherapists, speech therapists, occupational therapists, and social workers.
In order to keep you and your loved ones informed of progress, weekly meetings will be organized with you, your medical team, and your loved ones during the hospitalization. During your admission after the hemorrhage, we will discuss a treatment plan with you and your loved ones.
Your healthcare provider will discuss follow-up appointments, advice on life rules, and taking up activities with you and your loved ones before being discharged.
Daily activities after a cavernoma hemorrhage
The effects of a brain hemorrhage on resuming your daily life vary widely, depending on the severity of the hemorrhage. You will receive advice on how best to resume your daily activities, work and hobbies from the nursing specialist, rehabilitation doctor, and/or company doctor.
If you are recovering from the hemorrhage, possibly while waiting for the treatment of the cavernoma, there is often uncertainty about activities that increase the pressure on the head. Examples include flying, diving, going on a roller coaster, pushing, going to the sauna, or having sex. There are no indications that these activities increase the risk of new hemorrhage from a cavernoma. These activities can therefore be carried out as usual.
Driving after a cavernoma hemorrhageIf the cavernoma has hemorrhaged, a driving suspension of 6 months after the hemorrhage applies. If, after this period, there are any residual symptoms that affect driving skills, a report from your specialist will be required. On the basis of this report, the Dutch central driver licensing office (CBR) can decide whether an additional independent medical examination or a driving test is required. Your medical specialist will write the report in addition to the CBR's declaration of health (website in Dutch).