A diagnostic dilemma of intracranial pathology: coincidence or the result of cranial trauma?

• Published in: BMJ case reports Vol. 2010; no. nov22 1; p. bcr0720103167
• Main Authors: Cartwright, Georgina, Bailey, B M W, Lane, R J M, Messiha, A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 23.11.2010; BMJ Publishing Group
• Series: Unusual presentation of more common disease/injury
• Subjects: Assaults; Asymptomatic; Brain - pathology; Brain Neoplasms - complications; Brain Neoplasms - diagnosis; Convulsions & seizures; Diagnosis, Differential; Epilepsy; Epilepsy, Tonic-Clonic - complications; Epilepsy, Tonic-Clonic - diagnosis; Europe (West); Facial Injuries - complications; Facial Injuries - diagnosis; Head injuries; Hemangioma; Hemangioma, Cavernous, Central Nervous System - complications; Hemangioma, Cavernous, Central Nervous System - diagnosis; Hemorrhage; Humans; Intracranial Hemorrhage, Traumatic - complications; Intracranial Hemorrhage, Traumatic - diagnosis; Intracranial Hemorrhage, Traumatic - etiology; Intracranial Hemorrhages - complications; Intracranial Hemorrhages - diagnosis; Intracranial Hemorrhages - etiology; Literature reviews; Magnetic Resonance Imaging; Male; Motor Cortex - pathology; Muscle Weakness - complications; Muscle Weakness - diagnosis; Nervous system; Neurologic Examination; Pathology; Patients; Surgeons; Tomography, X-Ray Computed; Trauma; Unusual Presentation of More Common Disease/Injury; White; Young Adult
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr.07.2010.3167

A 21-year-old man presented to the accident and emergency department at St Peter's Hospital, London, in September 2008. Following consumption of alcohol, the patient had been assaulted and had experienced facial trauma. Later, the patient had a witnessed generalised tonic-clonic seizure and the next day noted weakness of the right leg. A CT scan of the brain revealed a solitary lesion in the left presylvian region close to the vertex, involving the leg area of the primary motor cortex. A subsequent MRI scan showed the lesion to be a cavernous haemangioma. The patient had no history of epilepsy. This raised the question as to whether the assault caused the lesion to haemorrhage, resulting in the seizure and spastic monoparesis, or did the formerly asymptomatic cavernoma bleed spontaneously with the assault being coincidental?