Multiple brain cavernomas and pregnancy: Risk of seizures during obstetrical management

Introduction: Cerebral cavernous malformations (CCMs) are linked to seizures and severe complications, including intracranial hemorrhage. Research on CCMs during pregnancy is limited, with only a few case series and observational studies available. This report examines the management of CCMs during pregnancy, emphasizing the risks of seizures and their treatment in the peri-gestational period. Case Report: A 25-year-old woman presented with vomiting, dizziness, diplopia, and difficulty walking. A magnetic resonance imaging (MRI) detected small brain lesions consistent with multiple cavernomas. Two years later, during her first pregnancy, she was closely monitored by an OBGYN team and underwent a cesarean section due to her pre-existing neurological condition. Afterward, she displayed mild symptoms but had stable neurological evaluations. Her second pregnancy was uneventful, yet she underwent another cesarean section. Following delivery, she had two seizure episodes and was prescribed levetiracetam. During her last follow-up, 18 months later, she remained stable and seizure-free. Conclusion: The risk of developing epilepsy during pregnancy, labor, or postpartum in CCM patients is unknown. Vaginal delivery is safe for certain patients; however, hormonal changes may increase seizure risk in those with pre-existing CCMs. Further research is required to clarify the relationship between CCMs and pregnancy and to optimize management strategies.