Tag: Sporadic

J Neurosurg 144:1017–1023, 2026

This clinical study assesses the diagnostic value of routine versus symptom-driven MRI follow-up in patients with sporadic cerebral cavernous malformations (CCMs), analyzing radiographic changes at the first postdiagnosis scan in a prospective single-center cohort. Results show that new or worsening focal neurological deficit (FND) strongly predicts symptomatic hemorrhage, while routine surveillance rarely detects acute hemorrhage.

Imaging progression—including lesion growth, Zabramski classification changes, T1 hyperintensity, and edema—occurred across indications but had limited impact on management when patients were asymptomatic. The authors recommend symptom-driven MRI, reserving routine surveillance for select cases and early posthemorrhage confirmation.

Objective Evaluate whether routine surveillance MRI vs symptom-driven MRI better detects hemorrhage in patients with sporadic, brain-only cerebral cavernous malformations (CCMs), and what radiographic changes appear at first follow-up.

Cohort/Design Prospective single-center registry analysis of 236 sporadic brain-only CCM patients who had ≥1 follow-up MRI after diagnosis; MRI indications categorized as routine vs symptom-driven (e.g., new/worsening focal neurological deficit [FND], headache, seizure).

Hemorrhage yield Radiographic hemorrhage at first follow-up occurred in 19.1% (13/68) of symptom-driven MRIs vs 1.2% (2/168) of routine/non–CCM-related surveillance MRIs.

Routine progression In routine/non–CCM-related surveillance (n=168), 10.1% showed radiologic progression (growth ≥3 mm, more aggressive Zabramski type, or hemorrhage), but acute hemorrhage was only 1.2%; 88.2% of progression events occurred within 2 years.

Imaging correlates of SH Symptomatic hemorrhage (SH) was associated with lesion growth, moderate-to-severe T1-hyperintensity, and edema at follow-up; baseline lesion size and location did not predict hemorrhage.

Symptom predictors New or worsening FND predicted hemorrhage, while seizure or headache alone did not; in multivariate analysis, only new/worsening FND remained independently associated with hemorrhage (OR 13.73, p<0.001).

Clinical implication Follow-up MRI is most justified when there is new or worsening FND; routine surveillance in asymptomatic patients has limited diagnostic yield but may be reasonable in select situations.

Special cases MRI may still be considered for atypical, prolonged headaches distinct from baseline and not responsive to over-the-counter medication, or for changing/new seizure patterns based on clinical judgment.