Vertigo due to cerebellar cavernous malformation: A case report

Abstract

Central vertigo is a result of vestibular structure dysfunction in the central nervous system. Currently, misdiagnoses between peripheral and central lesions are frequent, and diagnostic testing costs are high. Identifying the characteristics of these 2 conditions is challenging. We can provide better treatment if we can establish a diagnosis earlier. Cerebral cavernous malformation (CCM) at the cerebellum is a cerebellar lesion that causes symptoms of central vertigo. We report a patient, 20th years old, female, with vertigo for 1 month before being admitted. Vertigo was getting worse, and when the patient arrived at our hospital, vertigo was accompanied by headache, right and left abducens nerve palsy, horizontal nystagmus bidirectional, vertical nystagmus, and weakness on the right side of the body. A brain magnetic resonance imaging (MRI) was performed before surgery and shows a lesion suggestive of CCM at the cerebellum with a hemorrhagic component inside and non-communicating hydrocephalus. There is no vascular malformation based on digital subtraction angiography result. MRI is the most sensitive and specific modality for detecting CCM, whereas cerebral angiography rarely detects this malformation. The patient got surgical treatment, with suboccipital decompression procedures and CCM excision. The histopathological results after surgical treatment revealed a cerebral cavernous malformation. Vertigo, headache, double vision, and weakness on the right side of the body were resolved after surgery.

Keywords: CCM, Cerebral Cavernous Malformation; CNS, Central Nervous System; Cavernous malformation; Central vertigo; Cerebellar; DSA, Digital Subtraction Angiography; Hemorrhage; MRI, Magnetic Resonance Imaging.

Fig. 1

A brain MRI was performed prior to surgery. Yellow arrow in this picture shows the appearance of CCM on axial, coronal and sagittal view. MRA revealed no vascular malformations.

Fig. 2

There is no vascular malformation based on digital subtraction angiography.

Fig. 3

A histopathological examination was performed to confirm the diagnosis of cavernous malformation. Magnificient 100 times (A) and 200 times (B). There is part of brain tissue containing hemorrhages and blood vessels with thin and widened walls, some undergo hyalinization and form sinusoids.