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  • Propranolol Treatment of Cavernous Malformations with Symptomatic Hemorrhage

    Final Number:

    M. Yashar S. Kalani MD PhD; Joseph M. Zabramski MD, FACS; Aristotelis Filippidis MD, PhD; Robert F. Spetzler MD

    Study Design:
    Clinical trial

    Subject Category:
    Vascular Malformations

    Meeting: AANS/CNS Cerebrovascular Section 2016 Annual Meeting


    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.


    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.


    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.


    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.


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