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Clinics in neurology and neurosurgery of sport. Mass lesions: cavernoma
  1. G Davis1,
  2. G Fabinyi2,
  3. P Le Roux3,
  4. P McCrory4
  1. 1
    Cabrini Medical Centre, Malvern, Victoria, Australia
  2. 2
    University of Melbourne Department of Neurosurgery, Austin Hospital, Heidelberg, Australia
  3. 3
    Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4
    Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
  1. Correspondence to Associate Professor P McCrory, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia 3010; p.mccrory{at}unimelb.edu.au

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The advent of widespread access to MR scanning has meant that a wide spectrum of incidental findings are now detected and referred for advice and management. Although cavernous haemangiomas (or cavernomas) are one of the most common types of benign vascular malformations, their precise incidence is unknown. They can occur as single or multiple lesions and provide a real dilemma for an athlete who wishes to participate in contact sports. Before the advent of modern neuroimaging techniques, such lesions would typically present as haemorrhage or seizures rather than as incidental findings on brain scans. In this patient, their risks and suggested management is discussed.

Case study: cavernoma

A footballer is involved in a motor vehicle accident. The patient incurs a head injury and loses consciousness for 30 seconds. The patient attends the emergency department, where is found to be asymptomatic, with normal systemic and neurological examination findings. A CT scan of the brain is performed, which shows a lesion in the anterior right frontal lobe. And MRI scan of the brain confirms this as a solitary cavernous haemangioma (cavernoma) (fig 1). The treating clinicians order formal neuropsychology assessment and EEG, which are both normal. One week later, the patient attends your office seeking medical clearance to resume playing professional rugby. What recommendations do you make, based on the following considerations?

Figure 1

Axial MR brain scan (fast fluid-attenuated inversion–recovery (FLAIR) sequence) showing a single high-intensity cavernoma lesion (white arrow) surrounded by a ring of dark haemosiderin staining in the right frontal lobe.

  1. Does the presence of the cavernoma preclude the patient from returning to rugby or other contact sports?

  2. Would you recommend any other treatment (eg, gamma knife) in order to allow him to return to sport?

  3. If you permit him to play, is there any benefit from wearing a helmet and if so, does …

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