Rhabdomyolysis is a rare adverse reaction that has a previously established association with levetiracetam use, which selectively binds the synaptic vesicle glycoprotein 2A (SV2A). Its structural analogue, brivaracetam, is a new third-generation antiseizure medication that has a higher affinity for SV2A, and current data suggests it provides a more favorable adverse event profile. Here, however, we report a case of rhabdomyolysis requiring dialysis in which serum creatine kinase level increased rapidly for several days until brivaracetam was discontinued. The delayed creatine kinase peak, rapid decline upon discontinuation of brivaracetam, and prior association of rhabdomyolysis with levetiracetam strongly suggest a causal relationship. To date, there are three reported cases of brivaracetam-associated rhabdomyolysis in the food and drugs administration adverse event reporting system (FAERS). Despite its favorable side effects profile, the use of brivaracetam may be associated with life-threatening rhabdomyolysis.

Cavernous malformations are vascular lesions characterized by dilated blood vessels with minimal intervening brain parenchyma. Although often asymptomatic, they can present with seizures, headaches, or neurological deficits. Accurate diagnosis relies on magnetic resonance imaging, with characteristic features such as a \"popcorn\" appearance. We present a case of a 45-year-old male with chronic headaches and seizures who underwent an extensive work-up. Initial magnetic resonance imaging suggested a thrombosed aneurysm, with subsequent cerebral angiography being unremarkable, supporting the final diagnosis of a cavernous malformation. Conservative management, initiated for asymptomatic lesions, led to effective seizure control and improved quality of life. This case underscores diagnostic complexities in neuroradiology, emphasizing the need for careful consideration of differentials when faced with unexpected imaging results. Clinicians must remain vigilant for alternative explanations, recognizing the dynamic nature of optimal strategies in neurovascular medicine.

Cavernoma, also called a cavernous malformation, is a vascular malformation that happens during development. It tends to look like a berry-shaped lesion. In cerebral hemorrhagic cavernous malformations (cavernoma), T1-weighted imaging that shows hyperintense perilesional edema in brain masses is an unusual radiological finding. This sign\'s association with cavernoma is gaining prominence. We present the case of a 35-year-old female patient without significant medical history who reported a seven-day history of left-side weakness that began in the upper limb, progressed to the lower limb, and was associated with nausea. The non-contrast T1- T1-weighted images displayed a gradient of hyperintense content of the lesion with surrounding relatively hyperintense perilesional edema. The patient consequently underwent surgery to evacuate the hematoma and excise the lesion, which went uneventfully.

Brain stone is an umbrella term for benign intracerebral calcifications and may be associated with various diagnoses. The surgical decision should be made on a case-by-case basis. Sometimes, conservative management should be considered, irrespective of the underlying pathology. We present a critical case with a brain stone treated conservatively. A 17-year-old female patient was admitted to our department with a headache. The neurological examination revealed no abnormal findings. Cranial CT and MRI scans showed a contrast-enhanced, highly calcified lesion located deep in the white matter at the level of the left centrum semiovale. Surgery was found unnecessary. The patient presented no neurologic deficits or symptoms during the three-year follow-up period. In this case, the differential diagnosis included arteriovenous malformations (AVMs), cavernomas, calcifying pseudoneoplasms of the neuroaxis (CAPNON), etc. The localization of the lesion, expression of the symptoms, and potential outcomes of a possible surgery should be carefully estimated before making the final decision. In summary, conservative treatment should also be considered for critically located, benign calcified lesions, irrespective of pathology, unless they cause intense neurologic symptoms or deficits.

UNASSIGNED: Cavernous malformations are congenital or acquired vascular abnormalities. They are uncommon entities with an incidence of 0.5 % of the general population and usually are unnoticed until a hemorrhagic event occurs. Cerebellar cavernomas (CCMs) account for 1.2 to 11.8 % of all intracranial cases and 9.3 to 52.9 % of all infratentorial cases. Cavernomas can be concurrently seen with developmental venous anomalies (DVAs) in 20 % (range 20 %-40 %) of cases, in which case they are known as mixed vascular malformations.
METHODS: We report a case of a healthy young adult who presented with acute onset of headache, with characteristics of chronic headache that gets progressively worse. The patient complains of frequent dizziness when sitting and standing for a long time. Complaints have been felt for two years and have worsened for the past two weeks. Additional complaints are dizziness and nausea with intermittent episodes of vomiting for four days. Magnetic resonance imaging (MRI) revealed an underlying cavernoma that had bled and a coexisting DVA. The patient was discharged home with no deficits. Outpatient follow-up two months later showed no symptoms or neurologic deficits.
UNASSIGNED: Cavernous malformations are congenital or acquired vascular anomalies that occur in approximately 0.5 % of the general population. Our patient likely had dizziness due to localization of the bleeding of the cavernoma on the left side of the cerebellum. In our patient, brain imaging revealed numerous abnormal blood vessels radiating from the cerebellar lesion, a highly suggestive of DVAs associated with cavernoma.
CONCLUSIONS: A cavernous malformation is an uncommon entity that might coexist with deep venous anomalies, making management more challenging.

Cavernous malformation (CM) is a type of vascular malformation that is an important cause of intracerebral hemorrhage. However, because CM is a low-flow vascular malformation, the occurrence of major hemorrhage is rare. We present two patients with deep ganglionic intracerebral hemorrhage that caused a significant mass effect, mimicking hypertensive hemorrhage. In both cases, we performed evacuation of the hematoma as a lifesaving treatment and made a pathological diagnosis of CM. In conclusion, preoperative diagnosis of CM using any kind of radiological evaluation is difficult, especially in patients with major hemorrhage. The possibility of CM should be remembered in cases with deep ganglionic intracerebral hemorrhage.

To shed light on the role of relaxin in cerebral cavernous malformations (CCMs) in adults and children, the authors investigated endothelial cell (EC) expression of relaxin 1, 2, and 3; vascular endothelial growth factor receptor-1 and -2 (VEGFR-1 and -2); Ki-67; vascular geometry; and hemorrhage, as well as the clinical presentation of 32 patients with surgically resected lesions.
Paraffin-embedded sections of 32 CCMs and 5 normal nonvascular lesion control (NVLC) brain tissue samples were immunohistochemically stained with antibodies to relaxin 1, 2, and 3; angiogenesis growth factor receptors Flt-1 (VEGFR-1) and Flk-1 (VEGFR-2); and proliferation marker Ki-67. For morphometric analysis, Elastica van Gieson stain was used, and for hemorrhage demonstration, Turnbull stain was used. Data from the pediatric and adult CCMs were compared with each other and with those obtained from the NVLCs. Statistical analyses were performed with Fisher\'s exact test, the chi-square test, the phi correlation coefficient, and the Student t-test. A p value < 0.05 was considered significant.
Pediatric and adult cavernoma vessels did not significantly differ in diameter. Hemorrhage was observed in CCMs but not in NVLC samples (p < 0.05). There was no difference in expression of Ki-67, VEGFR-1 and -2, and relaxin 1, 2, and 3 in the ECs of pediatric and adult CCMs. The ECs of CCMs were largely negative for relaxin 3 compared to NVLCs (p < 0.05), whereas CCMs, compared to control brain tissue samples, more frequently expressed Flt-1 and relaxin 2 (p < 0.05). Ki-67 was not expressed in the NVLCs, but the difference was not statistically significant. Relaxin 1 and 2 expression and increased expression of VEGFR-1 were associated with a supra- versus infratentorial location (p < 0.05).
Relaxin 1 and 2 and VEGFR-1 play a role in supratentorial cavernomas. Relaxin 3 may play a physiological role in normal brain vasculature. Relaxin 1 and 3 are also found in normal cerebral vasculature. Relaxin 1, 2, and 3 are associated with increased VEGFR-1 expression.

To evaluate the value of radiosurgery with a rotating gamma-system (RGS) for cerebral cavernomas.
Seventy-nine patients with symptomatic cerebral cavernomas underwent RGS radiosurgery at the Bach Mai Hospital, Hanoi, Vietnam. Median dose (single fraction) was 20 Gy (range=14-26 Gy). Endpoints included effect on headache, seizures and tumor size.
Of 60 patients with headache, 17% had complete response, 82% partial response and 2% stable disease (best response). Of 39 patients with seizures, 31% had complete response, 64% partial response and 5% stable disease. Four patients developed recurrent seizures after 1 year. Regarding the size of cavernoma at 15 months, complete response was observed in 6%, partial response in 75%, stable disease in 15%, progression in 1% and pseudo-progression in 3% of patients. Bleeding within 2 years after RGS radiosurgery occurred in only five patients (6%). RGS dose had no significant impact on outcomes.
RGS radiosurgery provided very high rates of symptom relief in patients with cerebral cavernomas.

Cerebral cavernous angioma or cavernoma is a benign vascular malformation, usually asymptomatic. It is infrequent and often its discovery is incidental, a so-called incidentaloma. However, these lesions can be symptomatic, causing headaches, epilepsy, cerebral hemorrhage and other neurological signs depending on the brain area involved. Frontal localization is responsible for psychiatric disorders, particularly the prefrontal region, leading to prefrontal syndrome, a condition common in all frontal lobe tumors. Psychopathological syndrome can be depression-type, pseudodepression syndrome or maniac-type, pseudomaniac syndrome. Surgical treatment of lesions like this may not always be possible due to their location in eloquent areas. In this study, we describe an unusual association of migraine-like headache, epilepsy and frontal lobe pseudodepression late-onset syndrome in the same patient. We have considered this case interesting mainly for the rarity of both a headache with migraine features and for the late onset of pseudodepression syndrome. Pathophysiology underlying migraine-like headache and that concerning the late-onset pseudodepression frontal lobe syndrome seems to be unclear. This case leads to further hypotheses about the mechanisms responsible for headache syndromes and psychopathological disorders, in the specific case when caused by a cerebral frontal lobe lesion.

OBJECTIVE: To report a case of a patient with multiple cerebral cavernous malformations (CCM).
METHODS: A 22year old man with mild von Willebrand disease presented with two occipital CCM, one of them with acute hemorrhage. Genetic testing for CCM1-3 did not reveal a mutation. Over a period of 54months, the patient suffered 26 new CCM hemorrhages despite multiple treatment attempts including thalidomide, simvastatin and hemostatic factors. Only after initiation of propranolol, which has already been successfully used in three children with giant cerebral cavernoma, the occurrence of new CCM with hemorrhages was completely stopped already at dose of 30mg daily - now for a period of 26months and without any other medications.
CONCLUSIONS: This case suggests a protective role for propranolol in preventing the occurrence of new cerebral cavernoma with hemorrhages in adults with multiple CCM.