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Fritz-Georg Lehnhardt, MD; Ulrich von Smekal, MD; Benedikt Rückriem, MD; Werner Stenzel, MD; Michael Neveling, MD; Wolf-Dieter Heiss, MD; Andreas H. Jacobs, MD

Arch Neurol. 2005;62:653-658.

Background  Cerebral cavernous malformations (CCMs) are congenital vascular anomalies that can cause seizures, intracranial hemorrhages, focal neurological deficits, and migrainelike headaches. Magnetic resonance (MR) imaging has substantially facilitated diagnosis of CCM. It is now widely accepted that familial clustering with an autosomal dominant inheritance pattern should be suspected in cases of multiple lesions.

Objective  To determine by MR imaging the penetrance of cavernous malformations in a 3-generation family that included 5 members with typical clinical signs and diagnostic findings.

Methods  All family members underwent routine MR T1-weighted and T2-weighted spin-echo sequences in addition to MR T2-weighted gradient-echo sequences.

Results  Four family members had been symptomatic with either brainstem bleeding, headaches, or focal neurological signs. The gradient-echo sequences yielded a dramatically higher sensitivity with regard to lesion number and distribution.As in previous reports of familial CCM, an increase in lesion number with increasing age, changes in lesion characteristics, de novo occurrence in serial MR imaging over time, and the phenomenon of anticipation could be confirmed in this family.

Conclusion  Magnetic resonance gradient-echo sequences should be considered the method of choice for diagnosis of familial CCM.

Author Affiliations: Departments of Neurology (Drs Lehnhardt, Neveling, Heiss, and Jacobs), Radiology (Drs von Smekal and Rückriem), and Neuropathology (Dr Stenzel), University of Cologne, Cologne, Germany.

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