A case of bilateral cavernous hemangioma associated with intracerebral hemangioma

[Multimodal diagnostics of retinal cavernous hemangioma]

Cavernous hemangioma of the retina - a rarely occurring hamartoma that is predominantly found in the young age; it can be accompanied by cavernous hemangiomas of the skin and central nervous system. In Russian scientific literature this disease has not been described in sufficient detail. The article presents two clinical cases of incidentally diagnosed cavernous hemangioma of the retina. Multimodal diagnostics approach was used to confirm histological findings described in literature, which are characteristic of retinal cavernous hemangioma.

Retinal cavernous hemangioma: fifty-two years of clinical follow-up with clinicopathologic correlation

PURPOSE

To report long-term follow-up and histopathology of a retinal cavernous hemangioma and to review the literature on this subject.

METHODS

A newborn girl was noted immediately after birth to a have hyphema and vitreous hemorrhage in her left eye. The bleeding recurred throughout childhood and the etiology was not determined. Upon referral at age 22, a large retinal cavernous hemangioma was first recognized and recurrent hemorrhages continued, eventually leading to pain and secondary glaucoma. The patient declined treatment. At age 52, the hemangioma was stable in size, but ocular pain and blindness necessitated enucleation.

RESULTS

During the 52-year course, the fundus mass did not enlarge, but numerous episodes of hyphema and vitreous hemorrhage led to chronic glaucoma and eventual blindness. The main histopathologic finding in the disorganized globe was a retinal mass composed of large endothelial-lined vascular channels with thin walls, typical of a retinal cavernous hemangioma. The tumor extended anteriorly into the ciliary body, explaining the recurrent hyphemas. Additional chronic features included extensive fibrosis of the entire anterior segment, iris, and retina with proliferative vitreoretinopathy and widespread intraocular hemosiderosis from chronic hemorrhage. The patient has been free of pain since enucleation.

CONCLUSION

Retinal cavernous hemangioma is a congenital stationary lesion that can cause recurrent intraocular hemorrhage, fibrosis, glaucoma, pain, and blindness, requiring enucleation. Retinal cavernous should be included in the differential diagnosis of childhood hyphema and vitreous hemorrhage.

The ophthalmology of intracranial vascular abnormalities

PURPOSE

To provide a practical review of the ophthalmologic manifestations of intracranial vascular abnormalities.

METHODS

We reviewed ocular manifestations of the most common intracranial vascular abnormalities: intracranial aneurysms, carotid-cavernous fistulas, arteriovenous malformations, and cavernous malformations.

RESULTS

Unruptured aneurysms can compress the third cranial nerve and the anterior visual pathways. Ruptured aneurysms and subarachnoid hemorrhage can result in Terson syndrome and papilledema. Direct and indirect carotid-cavernous fistulas most commonly cause the classic triad of proptosis, conjunctival chemosis, and cranial bruit but can masquerade as chronic conjunctivitis. Arteriovenous malformations, with or without hemorrhage, may compress portions of the retrochiasmal pathways, causing visual field loss. Cavernous malformations, when in the brainstem, commonly cause abnormalities of supranuclear, nuclear, and fascicular ocular motility.

CONCLUSIONS

The ophthalmologist may be the first physician to encounter clinical manifestations of intracranial vascular abnormalities that may herald devastating neurologic complications. Prompt diagnosis facilitates appropriate management and therapy.