Introduction:
Cerebral cavernous malformations affect approximately 1 in every 250 adults. Most of these lesions are asymptomatic or have a relatively benign natural histories, but a small minority behave aggressively and present with recurrent episodes of hemorrhage. A safe and effective medical treatment option for the management of this group would be useful. Propranolol has recently been shown to be effective in the treatment of infantile hemangioma, a close pathologic counterpart of cavernous malformations. These results suggest a potential role for propranolol in the management of patients with cavernous malformations.
Methods:
Low-dose propranolol (20 mg, three times daily) was used to treat two adult patients who had symptomatic cavernous malformations and a history of repeated hemorrhage.
Results:
Two patients, a 54-year-old woman and a 57-year-old woman, were treated with low dose propranolol. Serial magnetic resonance imaging studies after the initiation of propranolol demonstrated regression of the lesions and no evidence of recurrent hemorrhage.
Conclusions:
Propranolol may offer a safe and effective treatment for patients who have cavernous malformations with symptomatic hemorrhage. We propose that a blinded, controlled, randomized trial is necessary to investigate the utility of this approach.
Patient Care:
Our research provides a potential medical treatment for a relatively common vascular malformation.
Learning Objectives:
To discuss a novel potential medical treatment for symptomatic cerebral cavernous malformations.