cavernoma activated by accident?

New members can introduce themselves here

cavernoma activated by accident?

Postby SueBlue » Sun Mar 02, 2014 1:07 am

Hi there,
I'm Sue and I have just had a cavernoma removed from my left frontal lobe three weeks ago. Surgery and recovery are going well and I'm already feeling better than before surgery :) .
I am writing, to find some answers to remaining questions. For that, I need to tell my story.

On September 4th last year I had an accident, where a car wiped me off my bike when it was setting out to turn right in front of me, across my straight lane, before starting to indicate. I pulled the breaks hard, while trying to steer away, but the left corner of the car's bumper hooked into my skirt and leggings and scraped into my right thigh, then began pulling me onto the bonnet. So I left go of the handlebar and flew forward, landing on the street mainly on my chin, right top incisor and nose, on the other side of the car. The bike followed me, and I felt the handlebar whack into the top of my skull on the left side (bouncing off my dread-locks preventing outer injury).
Directly after the accident, I managed to cycle on to work, where I saw the depth of my chin injury. I immediately went to A&E, where my wounds were taken care of, my chin was glued and I was advised to see my dentist. (The light test into my pupils showed no brain injury then.)

A fortnight after this accident, during the night of September 17/18 between 3-5 a.m., I had several severe seizures with breathing difficulties. An ambulance was called around 9.00 a.m. I was driven to the Neuro-Surgery at Cork University Hospital (Ireland), where they sedated me to take a CT scan. They found a bruise, or haemmorrhage of 1.5 x1.3 cm in my left frontal lobe (just under where the handlebar of the bike hit me), referring to injury received a fortnight before.
The follow-up CT's and MRI scan, all just before last Christmals, revealed that the haemmorrhage, which was now re-diagnosed as a cavernoma, had grown, not too fast, but enough to remove it. (I even remember feeling it grow like an extending burn-blister just under my scull.) The Neurosurgeon at Cork University Hospital in Ireland, Dr. Marks, did a great job removing the cavernoma and preventing any effects on my BROCA-speech-centre. I am still on Keppra and awaiting the doc's decision on driving (usually it's one year seizure free in Irleand).

But in one question, which is really important for my accident case (civil insurance case), he remains adamant: He believes I had the cavernoma growing there all my life, and it has nothing to do with my accident.
(He also believes he gave me my life back, and maybe he did, but I am slightly cautious, when it comes to doctors... and egoes...)
Now, I never had seizures in my 40 years long life before the accident, my general health is great, and I have survived many bike accidents, cycling at home in Germany. And in an MRI taken in 2000 in Germany, no such cavernoma is visible... I strongly believe (and my GP agrees), that the accident, which caused head trauma, probably caused the cavernoma to become symptomatic. Or it might even have been caused by the accident in the first place, as the handlebar hit me in the exact spot, under which the cavernoma grew.

I am looking for an expert who can advise me in support of a connection between the accident and the cavernoma, and whose advice might be useful for my case if brought to court. Or someone who could convince my Neurosurgeon (known as "the best" in Ireland), that this connection exists, and that my cavernoma might have been a case of "de novo", caused by the accident (he's known to be tough when it comes to insurance cases). I have my MRI scan available for a deeper insight.

It would be great if someone could point me in the right direction for finding such expert advice.
Thanks for your answers, I'm looking forward to finding help in this...
Best 2u all,
SueBlue
User avatar
SueBlue
 
Posts: 8
Joined: Sun Mar 02, 2014 12:24 am
Location: Carrigaline, Ireland

Re: cavernoma activated by accident?

Postby vandy » Sun Mar 02, 2014 6:25 pm

Hi Sueblue,

Welcome to the forum, even though it is under these circumstances.

Yes most likely the accident is responsible for the bleeding and subsequent seizures you experienced. I don't think we all would agree here. We are not Dr.'s but it seems pretty obvious.

When it comes to insurance cases, you need to get legal representation. These lawyers will arrange for you to have an Independent Medical Exam (IME) with a Neurosurgeon/Neurologist specialized in this field, who will confirm that the accident had caused the bleeding etc.

It is very difficult to do this without legal help.

Wishing you the best.

Henk :ugeek:
User avatar
vandy
 
Posts: 1040
Joined: Thu Sep 30, 2010 10:02 pm

Re: cavernoma activated by accident?

Postby SueBlue » Tue Mar 04, 2014 12:27 pm

Thanks for your answer, Henk.

Yes, I have a solicitor for my case, and she knows how tough Dr. Marks can be. We got her through my GP, who knows her personally. The GP mentioned, that the solicitor has the right to get an independent opinion on this, once my files are made available to her.
We were hoping, we could play into her hands by some expert advice on this while waiting for my post-op check-up. My partner tried to find some specific names of experts we could ask directly, maybe in the UK or US...

Search continues...
User avatar
SueBlue
 
Posts: 8
Joined: Sun Mar 02, 2014 12:24 am
Location: Carrigaline, Ireland

Re: cavernoma activated by accident?

Postby kirkmc » Wed Mar 05, 2014 2:26 pm

I've read a lot about cavernomas, and I've never seen anything to suggest that they can be caused by physical trauma. Also, I've never heard any suggestion that they can grow quickly. It's far more likely that the accident caused it to bleed, perhaps because of pressure in the brain.

De novo cavernomas can certainly form, and I don't think anyone knows why they do (other than when radiation therapy is used).

Another thought: if physical trauma were a common cause, we'd probably see tons of them among American football players...

Kirk
Two brainstem CAs in the pons. Big Bleed in July 2005, previous, undiagnosed bleeds in 1982 and 1987, and several smaller bleeds in the past few years. I live in a town in the French Alps. http://www.mcelhearn.com
User avatar
kirkmc
Site Admin
 
Posts: 469
Joined: Sat Sep 25, 2010 8:15 am
Location: A town in the French Alps

Re: cavernoma activated by accident?

Postby Michelle2000 » Thu Mar 06, 2014 2:46 am

I agree with Kirk. We believe that my son's brainstem bleed was caused by hitting his head hard on the mat while practicing double leg takedowns at wrestling practice. We didn't know he had them prior to that, and he was originally diagnosed and treated for concussion. His brainstem CM did "grow" quickly- a centimeter between MRIs a day and a half apart, but I doubt that was really the CM growing. More likely it was the clot that grew.

Best wishes on your continued recovery,

Michelle
17 year old son with brainstem CM resected in March 2010, CM at C2-C3,
CCM2 mutation; DH & BIL with multiples in brain and spine; (MIL - deceased spine & brain)
Michelle2000
Moderator
 
Posts: 709
Joined: Thu Dec 02, 2010 7:40 pm

Re: cavernoma activated by accident?

Postby SueBlue » Fri Apr 04, 2014 11:22 pm

Thanks for all your responses. Unfortunately, so far my treating neurosurgeon is even reluctant to answer the simple question, if the accident could have caused my cavernoma to bleed.
He thinks the bleed had nothing to do with the accident, even though the cavernoma was never sypmtomatic before... Luckily, it didn't "grow" fast, there were 3 months between the CT scans... so it might have been seeping since the accident...
I'm still working on making connections ... it's moving :-)
User avatar
SueBlue
 
Posts: 8
Joined: Sun Mar 02, 2014 12:24 am
Location: Carrigaline, Ireland

Re: cavernoma activated by accident?

Postby doctorjah » Tue May 05, 2015 1:51 am

Hello

I don't know if you are still looking for information, but I have a similar situation. I was in an auto accident several months ago, and shortly thereafter I noticed strange sensations when showering in a patch on my left abdomen, which expanded to a band all the way around my left side, and eventually led to lack of temperature and pin prick sensation on my left side from the bottom of my ribs to my foot. An MRI discovered a spinal cord cavernoma at T4, and a subsequent MRI showed that it continued to bleed, and was leading to motor issues with my right leg. The cavernoma was removed surgically about a month ago. Here are two papers showing a relation between trauma and cavernoma bleeds:

J Stroke Cerebrovasc Dis. 2006 Mar-Apr;15(2):74-8.
http://www.em-consulte.com/en/article/119576

I hope these are helpful.
Last edited by doctorjah on Tue Jun 02, 2015 11:36 am, edited 1 time in total.
doctorjah
 
Posts: 2
Joined: Tue May 05, 2015 1:35 am

Re: cavernoma activated by accident?

Postby doctorjah » Tue May 05, 2015 5:40 pm

Here is another paper showing that trauma can trigger bleeding in cavernomas:

Labauge et al (2008) Surgical Neurology 70:176-181.
Last edited by doctorjah on Tue Jun 02, 2015 11:37 am, edited 1 time in total.
doctorjah
 
Posts: 2
Joined: Tue May 05, 2015 1:35 am

Re: cavernoma activated by accident?

Postby SueBlue » Fri May 22, 2015 10:26 pm

Thank you for providing the information, John. I will work through it and comment later.

In the meantime I found out, that even the histology concludes that "no signs of a cavernoma were visible", they called it a "blod-clot" or lesion.
My consultants will still only see a speculative connection with the accident. I changed my Nuerosurgeon, who is very supportive and explained why the confusion happened, and confirmed that it was not a cavernoma. Then I also saw a Neurologist, who is convinced of a pre-existing lesion. He stated it might be possible, that the swellings from the contusion/concussion could have caused this lesion to bleed.
This is as far as they will go in their statements.
I am still not convinced of a pre-existing condition. We have yet to turn to Beaumont for an independent medical exam through my solicitor.
Currently we are waiting for the last reports from the above consultants.

I'll keep you posted! And best of luck yourself!!
Best2U
SueBlue
User avatar
SueBlue
 
Posts: 8
Joined: Sun Mar 02, 2014 12:24 am
Location: Carrigaline, Ireland

Re: cavernoma activated by accident?

Postby SueBlue » Fri Apr 22, 2016 2:12 pm

Hi everyone,

I have not written for a long time, but I am still in the same predicament. We have now had enough expert opinions to know that I definitely had a cavernoma. I personally did not know I had the condition as I never experienced any symptoms prior to my accident. I accept that the cavernoma was probably not CAUSED by the accident in a de novo fashion. However, I am still convinced that the cav was activated into haemmhorraging by the accident. We are still looking for an expert who would support this in writing. In relation to this I would be very happy to find answers for some of my questions below.

According to the information on the Angioma Alliance website, my case could have been a type 2 or type 3 bleed (First CT reports an acute haemmhorrage, Histology proved a thrombus):
"2. Thrombosis: due to the stagnant nature of the blood in the cavernous angioma caverns, a thrombus (locally developed blockage/clot) can develop which can cause re-routing of the slow internal blood flow as well as growth inside the lesion. Most times this is not clinically significant unless the lesion reaches a large enough size to impact surrounding brain tissue.
3. Gross hemorrhage: blood escapes the confines of the lesion resulting in the deposit of blood products in normal brain tissue around the lesion. It is this hemorrhage type that is most commonly associated with clinical symptoms."

On the Angioma Alliance website it also says: "Basically, obstruction or stenosis alters blood flow and venous pressure [...]. Since CCMs communicate freely with the venous system, anything that negatively affects venous system pressure or drainage can have dire consequences for the CCM itself."
In his video on the Angioma Alliance website, Mr. Awad says: “If blood-pressure can make you bleed in a normal brain, I’m sure it can make you bleed in the CCM. That’s basic.”

Here are my first questions:
The CT taken upon delivery into A&E after my grand-mal seizures did show a contusion and a haemmhorrage. Would you agree that a contusion causes swelling? Do I understand right, that an oedema refers to a gathering of lymph fluid? Would both these swellings in the confined space of the skull exert pressure on the venous system in the head? Could this highten the blood pressure?

Would the Angioma Alliance's information not point to the possibility of my cavernoma having been activated into haemmorrhaging by the swelling of the contusion?

Secondly, the website mentions to "stay away from roller coasters or any activity inducing strong gravitational force". Would an accident, where I was thrust through the air and landed hard on the road, chin first, be considered a gravitational impact?

In his video on the Angioma Alliance website, Mr. Awad says: “If you shake a brain, it can bleed in anybody. But if you already have some bleeding in the brain and you shake it, that area is going to be more likely to bleed.”
Could this be considered a second aspect of a direct connection of my cavernoma's haemmorrhage with my accident?

Mr. Awad continues on to point out: “So, you know, there was a big case, medico-legal, that was: 'Did the trauma cause my CCMs to bleed?' You know, millions of dollars were settled and what have you. The fact of the matter is: if you’re gonna have a massive injury, the part of the brain most vulnerable to bleed is the part that was already brittle.”

We need to supply our solicitors with appropriate information for my civil insurance case and would like to find out more about the medico-legal case Awad mentions. Can anybody point us to this or similar cases, involving haemmorrhage of cavernomas after head trauma?

It has now been 3 years since my accident, and it is upsetting for me having to defend my case when I was the one who got injured. As it is a civil case, we need to find support for the possibility of head trauma activating a brain cavernoma into bleeding, it does not have to be a 100% proof.

I hope somebody can help us find some answers. Thank you for your patience reading all this. I look forward to your comments.
Best2u all
Sue
User avatar
SueBlue
 
Posts: 8
Joined: Sun Mar 02, 2014 12:24 am
Location: Carrigaline, Ireland

Next

Return to Introductions

Who is online

Users browsing this forum: No registered users and 4 guests

cron