Recurrent Intracerebral Bleedings in Young Adults - Only Surgical Exstirpation Reveals Cavernous Angioma as Underlying Cause

We discuss the treatment of spontaneous intracerebral haemorrhages of unknown aetiology at first presentation that were followed by significant re-bleedings within a few weeks. Two cases and a short overview of the literature are presented. The patients were young adults who initially presented with mild clinical signs, in both cases due to a single supratentorial intracranial haemorrhage. The first diagnostic work-up including cranial MRI and conventional digital subtraction angiography did not reveal the underlying cause of the bleeding. At first, the patients were in a relatively good clinical condition and we decided to treat them non-surgically. However, within a few weeks, both patients were re-admitted with new cerebral bleedings and a clinical deterioration. An individual risk assessment led to a surgical extirpation of the haemorrhages in these patients. The intraoperative aspect and the histopathological examination revealed a single cavernous angioma as the underlying bleeding source. Based on these two cases we discuss the related diagnostic and therapeutic problems.