Brief Communication
Journal of Child Neurology
Intracranial Cavernomatous
Hemangiomas as a Cause of Childhood
Temporal Lobe Epilepsy
Suvasini Sharma, DM1, Naveen Sankhyan, DM1,
Sheffali Gulati, MD1, and Atin Kumar, MD2
Abstract
A 12-year-old boy presented with complaints of seizures since the age of 7 years. Seizure semiology was consistent with
origin from the right temporal lobe. Magnetic resonance imaging of the brain revealed a large right temporal and multiple
small intracranial cavernomatous hemangiomas. The imaging findings and clinical significance of cavernomatous hemangiomas are
briefly discussed.
Keywords
vascular malformation, epilepsy surgery, seizure
Received March 26, 2010. Received revised April 2, 2010. Accepted for publication April 2, 2010.
Case Report
A 12-year-old boy presented with complaints of seizures since
the age of 7 years. His seizures began with a brief aura of head-
ache. This was followed by left-sided upper limb posturing and
right-sided hand automatisms. Later during the seizure, there
were clonic limb movements on the left side. His seizure fre-
quency varied from twice or thrice a month to once in 6 months.
He had been treated with phenytoin and carbamazepine, on
which he had partial control. There was no past or family his-
tory of seizures. Birth and perinatal history were unremarkable.
His developmental milestones had been achieved at appropri-
ate ages. At the time of presentation, he was on phenytoin
6.5 mg/kg/d, and his last seizure had occurred 4 months ago.
He was studying in grade 5, with average scholastic perfor-
mance. Examination revealed an afebrile, alert child with
normal facies. He had a 2  2-cm hemangioma on the right
elbow. There were no other cutaneous abnormalities. Systemic
and central nervous system examination revealed no abnormal-
ities. On electroencephalography, there were frequent spikes
arising from the right temporal region. Magnetic resonance
imaging of the brain revealed a large rounded lesion in the right
frontotemporal region. The lesion was heterogeneously hyper-
intense on T2-weighted images (Figure 1A) with a hypointense
rim and multiple hypointense tubular areas within representing
hemorrhages of different ages. Gradient T2-weighted images
(Figures 1B and 1C) showed ‘‘blooming’’ of the lesion along
with multiple other smaller lesions in both cerebral and cere-
bellar hemispheres. A diagnosis of intracranial cavernomatous
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25(11) 1423-1424
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DOI: 10.1177/0883073810371226
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hemangiomas with symptomatic temporal lobe epilepsy was
concluded.
Discussion
Cavernous hemangiomas are true vascular malformations of
the venous system. On magnetic resonance imaging, they are
seen as well-circumscribed, reticulated, mixed signal intensity
lesions because of the mixture of oxyhemoglobin, deoxyhemo-
globin, and extracellular and intracellular methemoglobin sur-
rounded by an area of hypointensity that corresponds to
hemosiderin deposition.1 About 75% of intracranial caverno-
matous hemangiomas occur at supratentorial regions, espe-
cially at the cortico-subcortical junction within the frontal
and temporal lobes and in the basal ganglia.2 Cavernomatous
hemangiomas can occur as sporadic or familial cases. Although
originally thought to be congenital, it is now known that caver-
nomatous hemangiomas often arise de novo.1 Factors associ-
ated with this de novo formation include irradiation, genetic
1
Division of Child Neurology, Department of Pediatrics, All India Institute of
Medical Sciences, New Delhi, India
2
Department of Radiodiagnosis, All India Institute of Medical Sciences, New
Delhi, India
Corresponding Author:
Sheffali Gulati, MD, Division of Pediatric Neurology, Department of Pediatrics,
All India Institute of Medical Sciences, New Delhi 110029, India
Email: sheffaligulati@gmail.com
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Figure 1. T2-weighted axial magnetic resonance image (A) showing a heterogeneous signal intensity lesion in right frontotemporal region with
hypointense rim and focal hypointense areas within. The lesion shows ‘‘blooming’’ on gradient T2-weighted axial image (B). Multiple other focal
lesions (arrows) are identified in other areas on this gradient image. Gradient T2-weighted axial image at a lower level (C) shows multiple
cavernomas in bilateral temporal lobes (white arrows). Note the lesions in cerebellum (black arrows).

causes, viruses, and seeding along biopsy tracts.1 Seizures are
the most common clinical presentation. Medically refractory
epilepsy has been reported with temporal lobe cavernomas.3
This could be a result of chronic or recurrent microbleeding
within the cavernomatous hemangiomas.4 Cavernomatous
hemangiomas can also cause intracerebral bleeding and
focal neurological deficits. In conclusion, cavernomatous
hemangiomas are a rare cause of epilepsy in childhood. The
diagnosis is established by the characteristic imaging findings.
Contributors
SS worked up the case, and SS and NS reviewed the literature and
drafted the manuscript. AK provided radiological input. SG was in
charge of the case and approved the final draft.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to
the authorship and/or publication of this article.
Funding
The authors received no financial support for the research and/or
authorship of this article.
References
1. Tortori-Donati P, Rossi A, Biancheri R. Capillary-venous
malformations. In: Tortori-Donati P, Rossi A, eds. Pediatric
Neuroradiology. Berlin, Germany: Springer Publications;
2005:319-328.
2. Rivera PP, Willinsky RA, Porter PJ. Intracranial cavernomatous
malformations. Neuroimaging Clin N Am. 2003;13:27-40.
3. Armstrong DD. The neuropathology of temporal lobe epilepsy.
J Neuropathol Exp Neurol. 1993;52:433-443.
4. Mottolese C, Hermier M, Stan H, et al. Central nervous system
cavernomas in the pediatric age group. Neurosurg Rev. 2001;
24:55-71.

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