Annual Risk of Hemorrhage for Coincidental Cerebral Cavernomas
The annual risk of hemorrhage for a coincidental (asymptomatic) cerebral cavernoma is approximately 0.6% per year, while previously symptomatic cavernomas have a higher risk of 4.5% per year. 1, 2
This risk varies based on several important factors:
- Location: Deep-seated cavernomas (brainstem, thalamus, basal ganglia) have higher bleeding risks than superficial lesions 1
- Prior hemorrhage history: The strongest predictor of future hemorrhage 2
- Genetic factors: Familial cavernomas have higher hemorrhage rates (4.3% to 6.5%) compared to sporadic cases (0.4% to 3.1%) 3
- Associated vascular anomalies: Presence of developmental venous anomalies increases hemorrhage risk by 4.6 times 4
- Patient age: Younger patients (<45 years) have approximately 2.2 times higher risk 4
For brainstem cavernomas specifically, the annual hemorrhage rate is higher, estimated at 5% per lesion per year 5, with recurrent hemorrhage rates ranging from 5% to 60% per patient-year 6.
MRI with T2-weighted gradient-echo sequences or susceptibility-weighted imaging remains the diagnostic modality of choice for detection and monitoring of cavernomas 1.