CM ? re: Pregnancy, hypertension, vaginal delivery

Discussions of issues related to living with cavernous angiomas

CM ? re: Pregnancy, hypertension, vaginal delivery

Postby alsgirl2002 » Tue Oct 12, 2010 3:53 pm

Hello, I am new here. I can't believe I didn't find this site earlier. August of 2009 I was diagnosed with a 5mm cavernoma abutting my left hypothalamus and left optic nerve. I will cut my story short, but after suffering from months of (apparently unrelated) migraines and getting a repeat MRI, found that my lesion was stable at 5mm in February. Of 3 different neurologists (2 at Johns Hopkins and 1 at University of Michigan Ann Arbor), none of them seem concerned about the lesion and all they have to say is if it bleeds I will have a siezure. I don't really believe that since my MRI shows hemosiderin deposits so it must have bled at some point, right? I have never had a seizure, and outside of the recent migraines, do not seem to ever have had any symptoms related to the CM.

My issue is this. My husband and I decided to conceive knowing of the CM, but not fully understanding the risks. Like I said, the drs really haven't had much to say to me, in fact, I am currently taking daily low dose aspirin! Well, my OB wanted a consult by my neuro for vaginal delivery. My neuro wouldn't say either way if there was any risk of a bleed associated with actual delivery (though I see on this site that it is safe?). I see my neuro tomorrow to follow up on this and some other symptoms I'm having. So here I am trying to find out if it really is safe for me to have a vaginal delivery? Does anyone have any insight into this?

The other question I have is if anyone knows whether vasospasm in the brain or hypertension could be an issue for the CM? I am 32 weeks now and am starting to have blood pressure problems which could be related to pre-eclampsia. This is a complication that I anticipated since I had it mildly with my last pregnancy, but holds new meaning now. The other thing with pre-eclampsia is that it definitely has neurologic implications such as brain swelling, so if I am developing it, I wonder what the implications of the swelling could be regarding the CM? Does anyone know if there has ever been a case study of pre-eclampsia and CMs?

Thanks for your help!
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Re: CM ? re: Pregnancy, hypertension, vaginal delivery

Postby Elizabeth » Tue Oct 12, 2010 5:25 pm

First of all....congratulations! You've already made it to 32 weeks... rather uneventfully as it that is really good news! Also, you said you had mild pre-eclampsia with your last pregnancy. Did you have a vaginal delivery last time? Did it go neurological problems afterwards for you? If that's the case, I think you're in good company with many cm women that have normal pregnancies and uncomplicated vaginal deliveries.

As far as the research goes, I'm not sure there are any specific answers to your questions. (Isn't that always the case with these things...ARRR?) More research is soooo needed so that we can rest in knowing the real answers! Anyway, all my problems started after I had my first (and so far only) baby. I had a very difficult delivery (one week over-due, induced labor which lasted 3 days, baby's head was positioned the wrong way making it harder, 2.5 hours of pushing with vacuum, 8 lb baby...blah blah). It was really hard and if I knew I had this thing in my head I would have never pushed as hard as I did and would have ended up with a c-section. I think my delivery caused me problems, but that's not the case for many women. After finding my cm (6 months post-partum...because I never became "normal" again), I asked my OB how she normally handles "us". She said she's had 3 patients that knew they had cms and all three had vaginal problems. She said she just tries just try to keep the pushing to a minimum....not so lucky for me! Second babies tend to be easier too...maybe lucky for you. Some mds recommend c-sections to avoid all pushing but I think there is really not a clear cut answer; and some obs argue that c-section is more risky because of more significant blood loss, rapid fluid volume changes, and possibly rapid blood pressure changes.

After being diagnosed, I started reading everything I could about pregnancy and cms. I think I read every article on pub-med because I really wanted answers (and I would like another baby :) ) After all my reading and seeing a ton of specialists....there seems to be no clear answers on most all of my questions which are similar to yours! But.. there did seem to be some pretty strong evidence that pregnancy has been correlated with lesion "growth"...while no one agrees that pregnancy causes "bleeds". Just curious, have you had an MRI during pregnancy...if so any changes?

Best of luck and health for you and your baby! Let us know how it goes.
Diagnosed September '09 with one CM centered in the right insular cortex/basal ganglia. Saw many, many doctors and had surgery 12/10/10 with Dr. Spetzler. I am thrilled to have this bleeding thing out of my head even though I suffered a stroke during surgery. Have had/ continue to make an amazing recovery.
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Re: CM ? re: Pregnancy, hypertension, vaginal delivery

Postby ajlong17 » Tue Oct 12, 2010 5:44 pm

Congratulations on your pregnancy! There's not much I can add from Elizabeth's post, which was full of great information, but the one thing that my neurologist told me was that I should have a high risk OB. I've also been told, not by my neurologist, but by my boyfriend's aunt who is an OB, that I should probably have a C-section when the time comes because the strain of natural birth tends to exacerbate any symptoms. Of course, as Elizabeth said, there are different schools of thought on that as well.

Please post back and let us know how it goes for you. I'm wishing you all the best!
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Re: CM ? re: Pregnancy, hypertension, vaginal delivery

Postby alsgirl2002 » Wed Oct 13, 2010 6:20 pm

Thanks for the responses ladies. I did have a vaginal delivery last pregnancy. It was uneventful. I was induced at 37w and my daughter was small at 5lb15oz, so that made my delivery pretty easy. It wasn't until probably 9 months postpartum that I was diagnosed. It appears to be an incidental finding, but that isn't totally clear. I went to the ER in Aug '09 with a visual scintillation in my left eye that I have been told is unrelated to my CM. I don't really believe them since the CM appears to abut the left optic nerve and is located between the left hypothalamus, the optic chiasm, and the ventricle. My neuro said the only way that my visual problem could be explained as being related is if the lesion is between the eye and the crossing of the two optic nerves. Everything is so closely located here that I have a feeling that this is the case.

I had my neuro appt today and it went as well as could be expected. He classified my headaches that I've been having as either migraines or blood pressure related. He said many of the other symptoms I am having (which I didn't get into in my prior post) are probably due to plain old pregnancy. He did say that my wooziness and vertigo could be an indicator of a lesion in my brainstem, but at this time my symptoms probably aren't significant enough to outweigh the risks of an MRI while pregnant. I suppose if my symptoms don't resolve after birth I will have a repeat MRI.

I did get a lot more info out of him on my lesion than before. He said that 3 things could happen. It might not ever bleed or leak, even though there is evidence that it has in the past. If it leaks, I probably will have some sort of visual deficit as a symptom, but I might have no symptoms. Finally, the risk of an acute/significant bleed is very small, but if it does happen I will have consequenses similar to an anuerism since the lesion is located adjacent to the ventricle. I'm not thrilled to hear that but I guess I always knew that it was a possibility. He said that the choice to deliver vaginally or via c/s should be based upon obstetric considerations not related to my lesion. He said that they are unaware of any additional risks that vaginal delivery might have on the status of my lesion. We did discuss the studies on pregnancy and bleeds, which I was previously aware of through my own research. We discussed the risks of hypertension, and he indicated that it would increase the risk of a bleed, but that vasospasm would probably not have any effect. He actually said that considering my additional medical history that he would also recommend maintianing the daily low dose aspirin. So a very thorough appt as I expected. Does this all make sense?
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Re: CM ? re: Pregnancy, hypertension, vaginal delivery

Postby rachel_hart » Sat Oct 16, 2010 1:28 am

Congrats on your pregnancy! I was diagnosed with my angioma three years ago after suffering a miscarriage. Soon after my miscarriage I began having terrible, daily headache. I had an MRI and was diagnosed with my CM. My neuro surgeon did tell me that pregnancies CAN increase your CMs likeliness to bleed because of the increase in estrogen and blood flow your body experiences during pregnancy. I hope this info helps you!
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