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Pediatric Cerebral Cavernous Malformation

Pediatric cerebral cavernous malformations may increase the risk of traumatic brain injuries when head trauma occurs during birth. However, the presence of a cerebral cavernous malformation does not relieve negligent health care providers of liability.

Cerebral cavernous malformations affect approximately one in 200 people. An estimated 20 percent of cerebral cavernous malformations are inherited, according to the Mayo Clinic. If either parent has a family history of these malformations, the offspring has a 50 percent chance of developing one or more.

Children with this condition often live normal lives without symptoms or complications stemming from cerebral cavernous malformations. However, they are more susceptible to brain damage from intracranial hemorrhages if head injuries occur. This includes head injuries during birth.

What are the symptoms and complications of a cavernoma?

A cerebral cavernous malformation (CCM) is an abnormal growth of capillaries in the central nervous system (brain and spinal cord). These capillaries grow in tightly packed formations, also called lesions, and are unable to provide a useful blood supply to tissues.

Cerebral cavernous malformations are most prevalent in the brain stem, spinal cord, and basal ganglia. A cavernous malformation is often described as shaped like a mulberry. Cavernous malformations are also called:

  • Cavernoma
  • Cavernous angioma
  • Cavernous hemangioma

Although a cavernous malformation is made up of capillaries, the capillaries don’t have a normal capillary structure. Their walls are thinner, which makes them more fragile and thus more likely to bleed.

Many people who have cerebral cavernous malformations experience no symptoms and may not be aware they have this condition. Johns Hopkins Health estimates that around 25 percent of people with cerebral cavernous malformation never experience symptoms.

However, others do experience symptoms, which may range from mild to severe. The most common symptoms of cerebral cavernous malformation include:

  • Seizures
  • Hemorrhage (bleeding into the brain or spinal cord)
  • Headaches
  • Neurological deficits

Bleeding from a cerebral cavernous malformation can cause serious neurological complications. In severe cases, it can result in brain damage, stroke, and death. In infants and young children, it can be difficult to differentiate symptoms of cerebral cavernous malformation from other developmental issues.

How is a cerebral cavernous malformation diagnosed?

Cavernomas are typically diagnosed using computed tomography (CT) scans or magnetic resonance imaging (MRI) to view two- or three-dimensional brain images. These images can also detect bleeding that may have occurred.

Can a cavernoma be diagnosed in a developing fetus?

In-utero diagnosis is not always possible due to limitations in imaging capabilities in most clinical settings. A few specialized university hospitals offer an ultrafast fetal MRI that uses the snapshot method to obtain high-resolution images. MRI is a safe procedure that does not use radiation.

How are cerebral cavernous malformations treated?

If your child is asymptomatic, treatment for a cerebral cavernous malformation is generally unnecessary. Your child’s doctor will perform regular MRIs to determine whether the lesion is growing. As long as the cavernoma remains uncomplicated, the risks of treatment will generally outweigh the benefits.

A little boy playing

If your child does experience symptoms, treatment options include the following:

Radiosurgery is a procedure that directs radiation to the malformation to cut off the blood supply. This is a long-term procedure that may take years to take effect. However, it has a fairly high success rate without impacting surrounding brain tissue.

fMRI is an advanced procedure that maps your child’s brain functions to maximize the safety of surgery.

Cerebral Cavernous Malformation Treatment Centers

Cavernomas are rare, and relatively few practitioners have experience treating them. The following treatment centers have been recognized as Clinical Centers of Excellence in treating this condition:

What if I am pregnant and have one or more cerebral cavernous malformations?

Cerebral cavernous malformations often have no adverse effects on pregnancy and delivery. However, complications are possible, so your pregnancy should be managed by a team of doctors that includes an obstetrician experienced with high-risk pregnancies and a neurologist who is knowledgeable about cavernomas and familiar with your history.

Brain Hemorrhage Risks During Pregnancy

Numerous studies have found that pregnancy does not increase the risk of a maternal brain bleed.

Seizure Risks During Pregnancy

If you have ever experienced seizures because of your cavernomas, you may have a reduced seizure threshold while pregnant. If you take seizure medication, you may need to have your dose adjusted.

Seizure Medication Risks

Anti-seizure medications during pregnancy increase the risk of birth defects, especially neural tube defects, according to the Mayo Clinic. These medications can lead to the development of a bleeding disorder in the infant shortly after birth. Maternal supplementation with vitamin K during the last month of pregnancy may reduce this risk.

Seizures During Pregnancy

Convulsive seizures can deprive you and the fetus of oxygen, resulting in permanent brain damage or fetal death. A fall or other injury during a seizure could also cause irreparable harm. Despite these risks, if you are prone to seizures, the risks of medication may outweigh the risks of a maternal seizure during pregnancy.
The majority of babies born to women with epilepsy do not experience birth defects. Folic acid supplementation throughout pregnancy and even before conception may prevent neural tube defects.

Complications During Labor and Delivery

While vaginal deliveries are the reasonable standard of care in most cases involving maternal cavernomas, complications during childbirth can be dangerous for an infant with this condition. Due to the fragile nature of the capillaries in the cavernoma, any head trauma that occurs during the birthing process could result in a catastrophic brain bleed.

Bleeding in the brain causes damage to brain tissue and could increase pressure on the brain. The impact of a brain bleed varies based on the extent of the bleeding and the part of the brain that is affected. The effects of an intracranial hemorrhage include the following:

  • Changes in blood pressure
  • Tachycardia or bradycardia
  • Seizures
  • Rapid brain damage
  • Death

How does head trauma happen during birth?

The mere existence of a cerebral cavernous malformation does not increase an infant’s risk of experiencing a head trauma, but it can increase the risk that a head trauma will result in a brain bleed.

Long, complicated deliveries increase the risk of head and brain injuries. The following medical errors may cause head trauma during birth:

  • Excessive pulling on the newborn
  • Improper use of forceps or vacuum extraction
  • Failing to perform a timely cesarean section for a breech presentation
  • Vaginal delivery when placenta previa is present

Is my doctor liable for my baby’s birth injuries?

Whether your baby has suffered brain damage during the birthing process or a birth defect from medications prescribed to treat cavernoma symptoms, you must prove your doctor was negligent before you can prevail in a medical malpractice lawsuit.

Establishing negligence in any birth injury case requires a comparison between your doctor’s conduct and the reasonable standard of care. If the doctor violated the reasonable standard of care and your baby’s injuries are the result of that violation, your doctor may be liable.

Liability for birth injuries extends to any negligent health care provider, including the following:

  • Doctors involved in your prenatal care
  • Doctors who participated in your delivery
  • Nurses
  • Midwives
  • Pharmacists
  • Hospitals

In addition to birth errors, negligence leading to birth injuries may occur during prenatal care. If you have a cerebral cavernous malformation, such errors may include the following:

  • Failure to prescribe appropriate medication to manage the symptoms of your cavernoma
  • Failure to minimize risks through appropriate supplementation
  • Failure to monitor your symptoms or take them seriously
  • Failure to diagnose conditions secondary to your cavernoma
  • Failure to consider the possibility of a cerebral cavernous malformation in the fetus

What should I do if my child has birth trauma or birth defects involving a cerebral cavernous malformation?

If your child has suffered a birth injury because of negligence, the Birth Injury Center can help you get justice and recover compensation for your baby’s injuries. Contact us today to schedule a free consultation.

Written by:
Birth Injury Center Team

The Birth Injury Center aims to create informational web content and guides to help women and their families seeking support and guidance for birth injuries caused by medical negligence. All of the content published across The Birth Injury Center website has been thoroughly investigated and approved by medical expert Natalie Speer, RNC-OB, Attorney Ryan Mahoney, and Attorney Rick Meadows.