Propranolol stops progressive multiple cerebral cavernoma in an adult patient

Objective: To report a case of a patient with multiple cerebral cavernous malformations (CCM). Observation: A 22 year old man with mild von Willebrand disease presented with two otcipital CCM, one of them with acute hemorrhage. Genetic testing for CCM1-3 did not reveal a mutation. Over a period of 54 months, 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 30 mg daily- now for a period of 26 months and without any other medications. Conclusion: This case suggests a protective role for propranolol in preventing the occurrence of new cerebral cavernoma with hemorrhages in adults with multiple CCM. (C) 2016 Elsevier B.V. All rights reserved.