Propranolol stops progressive multiple cerebral cavernoma in an adult patient

Matthias Reinhard; Florian Schuchardt; Stephan Meckel; Jürgen Heinz; Ute Felbor; Ulrich Sure; Ulrich Geisen

doi:10.1016/j.jns.2016.04.053

Propranolol stops progressive multiple cerebral cavernoma in an adult patient

J Neurol Sci. 2016 Aug 15:367:15-7. doi: 10.1016/j.jns.2016.04.053. Epub 2016 May 6.

Authors

Matthias Reinhard¹, Florian Schuchardt², Stephan Meckel³, Jürgen Heinz⁴, Ute Felbor⁵, Ulrich Sure⁶, Ulrich Geisen⁷

Affiliations

¹ Department of Neurology, University Medical Center Freiburg, Germany; Department of Neurology and Clinical Neurophysiology, Medical Center Esslingen, Academic Teaching Hospital of the University of Tübingen, Germany. Electronic address: m.reinhard@klinikum-esslingen.de.
² Department of Neurology, University Medical Center Freiburg, Germany.
³ Department of Neuroradiology, University Medical Center Freiburg, Germany.
⁴ Department of Internal Medicine, University Medical Center Freiburg, Germany.
⁵ Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald, Germany.
⁶ Department of Neurosurgery, University Medical Center Essen, Germany.
⁷ Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Germany.

PMID: 27423555
DOI: 10.1016/j.jns.2016.04.053

Abstract

Objective: To report a case of a patient with multiple cerebral cavernous malformations (CCM).

Observation: A 22year old man with mild von Willebrand disease presented with two occipital CCM, one of them with acute hemorrhage. Genetic testing for CCM1-3 did not reveal a mutation. Over a period of 54months, the patient suffered 26 new CCM hemorrhages despite multiple treatment attempts including thalidomide, simvastatin and hemostatic factors. Only after initiation of propranolol, which has already been successfully used in three children with giant cerebral cavernoma, the occurrence of new CCM with hemorrhages was completely stopped already at dose of 30mg daily - now for a period of 26months and without any other medications.

Conclusion: This case suggests a protective role for propranolol in preventing the occurrence of new cerebral cavernoma with hemorrhages in adults with multiple CCM.

Keywords: Cerebral cavernoma; Hemophilia; Intracerebral hemorrhage; Propranolol; Thalidomide; Willebrand.

Publication types

Case Reports

MeSH terms

Brain / diagnostic imaging
Brain / drug effects
Disease Progression
Follow-Up Studies
Hemangioma, Cavernous, Central Nervous System / diagnostic imaging
Hemangioma, Cavernous, Central Nervous System / drug therapy*
Hemangioma, Cavernous, Central Nervous System / genetics
Humans
Male
Neuroprotective Agents / therapeutic use*
Propranolol / therapeutic use*
Treatment Outcome
Young Adult

Substances

Neuroprotective Agents
Propranolol