Clinical reasoning: cerebral cavernous malformations.

Lama M. Chahine, MD Michel J. Berg, MD SECTION 1 A 40-year-old man presented for management of seizures. His first seizure was 5 years earlier. Evaluation at that time revealed a hemorrhagic lesion near the occipital horn of the left lateral ventricle. Incomplete surgical excision was performed with indeterminate pathology suggestive of an astrocytoma. MRI demonstrated 7 separate lesions consistent with cavernous malformations. One measured 1.5 cm in diameter with T2 heterogeneous signal surrounded by a rim of low signal in the medial left temporal lobe. His current seizures have a complex partial semiology and occur 2– 4 times per month despite treatment with 2 antiepileptic drugs (AEDs).