Brainstem cavernous malformations are considered for surgical resection when there is repeat hemorrhage, progressive neurological deficit and superficial location. Surprisingly and inexplicably, these do not appear to be amenable to radiosurgery and such treatment is frequently complicated by a high incidence of radionecrosis. It is relatively common and may result from a myriad of causes. The majority of ICH is related to hypertension and is typically seen in specific regions, such as the basal ganglia, thalami, pons and cerebellum. Other more common causes include cerebral amyloid angiopathy, hemorrhagic transformation of infarction, tumors, anticoagulation, drugs such as cocaine, aneurysms and AVMs.
Clinical suspicion coupled with confirmatory imaging studies makes the diagnosis.
Acute treatment in the intensive care unit is aimed at stabilization, and subsequent subacute and chronic treatment is undertaken for rehabilitation and treatment of underlying disorders. Patients are managed by aggressive medical treatment and with surgery in selected instances in which patients become refractory to medical management. Other specialists are also involved in the provision of care. Neurosurgeons are frequently involved in the prevention and treatment of this most common and potentially devastating condition. Furthermore, CEA may be beneficial in asymptomatic patients with high-grade carotid stensosis as well.