Clinical presentation and optimal management for intramedullary cavernous malformations

The MR imaging findings are diagnostic for intramedullary CMs; these lesions abut a pial surface and have a characteristic imaging pattern. Spinal intramedullary CMs present with either an acute onset of neurological compromise or a slowly progressive neurological decline. Acute neurological decline occurs secondary to hemorrhage inside the spinal cord. Chronic progressive myelopathy occurs due to microhemorrhages and resulting gliotic reaction to blood products. Surgery and total removal of the lesion tends to halt progression of symptoms.