Introduction: Cavernous hemangiomas are benign congenital vascular abnormalities. Intracerebral cavernous hemangiomas have an appreciable risk of spontaneous hemorrhage. There is currently little knowledge as to whether head trauma increases the risk of bleeding for these lesions. In this study, we present three patients with post-traumatic nonspontaneous hemorrhage of intracerebral cavernous malformations (CM). We establish for the first time (to our knowledge) trauma as a risk factor for acute hemorrhage in intracerebral cavernomas.

Methods: We reviewed the charts of all patients with a new diagnosis of intracerebral cavernoma at our pediatric hospital between 2010 and 2014. Patients with a history of head trauma prior to presentation were subsequently studied to identify features common to these post-traumatic, hemorrhage-prone lesions.

Results: History of head trauma was identified in 3 of a total of 19 cases. These three patients presented with seizures and/or headaches and were found to have acute hemorrhage within a cavernous hemangioma. None of these patients had any previous history of abnormal neurological symptoms. All three abnormal vascular lesions had associated developmental venous anomalies (DVA). The three patients underwent surgical resection of their respective vascular abnormalities, and the diagnosis of cavernous hemangioma was confirmed with post-surgical tissue pathology. All three patients had complete resolution of symptoms following complete excision of their lesions.

Conclusions: Trauma is a risk factor for acute hemorrhage in patients with CM. The presence of associated DVA may represent a risk factor for post-traumatic hemorrhage of cavernomas. Surgical excision should be considered in such cases, if feasible. Athletes with known intracerebral CM should be counseled about the potential risks associated with contact sports.

Patient Care: Recognition of trauma as a risk factor for acute hemorrhage in cavernous malformations should affect the clinical algorithm for individuals harboring such lesions. These patients should be counseled about the potential risks associated with contact sports. In addition, appropriate precautions, such as the use of helmets, should be strongly enforced in this patient population.

Learning Objectives: - Recognize trauma as a risk factor for acute hemorrhage in cavernous malformations. - Appropriately counsel patients and families of patients harboring cavernous malformations about the potential risks of contact sports

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