{Reference Type}: Case Reports
{Title}: Symptomatic Brain Hemorrhages from Cavernous Angioma After Botulinum Toxin Injections, a Role of TLR/MEKK3 Mechanism? Case Report and Review of the Literature.
{Author}: Koskimäki J;Zhang D;Carrión-Penagos J;Girard R;Piedad K;Polster SP;Lyne S;Stadnik A;Awad IA;
{Journal}: World Neurosurg
{Volume}: 136
{Issue}: 0
{Year}: Apr 2020
{Factor}: 2.21
{DOI}: 10.1016/j.wneu.2019.12.172
{Abstract}: <B>BACKGROUND: </B>Cavernous angiomas (CAs) are vascular malformations that may result in stroke.<BR><B>METHODS: </B>Herein, we evaluate a CA patient with chronic migraine who experienced 2 documented symptomatic hemorrhages after receiving respective high doses of botulinum toxin (Btx).<BR><B>CONCLUSIONS: </B>Recently, bacterial lipopolysaccharide has been reported to contribute to CA development through Toll-like receptor signaling, causing hemorrhagic angiogenic proliferation. Lipopolysaccharide and Btx share a common intracellular signaling pathway driving CA development and hemorrhage. Significance of these observations is demonstrated by previous works on plasma molecules showing prognostic associations with symptomatic hemorrhages in human CA, related to the same canonical pathways. Authors suggest careful tracking of the association of Btx and hemorrhage in CA patients.