Hemorrhage of a cavernous malformation associated with accidental electrocution: Case report and review of the literature
A 19-year-old male electrician was working at a commercial job site when his right hand came in contact with 277 V of alternating current (AC). He was in contact with the high voltage wire for only a few seconds before it knocked him off his ladder landing on his feet. He did not suffer any trauma and had no obvious physical injuries. The patient reported no abnormal findings, until the next day when he began to feel nauseous and tired. He continued to decline over the next 4 days with progressively increasing nausea, emesis, and lethargy until a friend brought him to the emergency department (ED) because he was somnolent. A computed tomography (CT) examination of his head revealed a left thalamic/midbrain “overt” hemorrhage with hydrocephalus []. An external ventricular drain was placed and he clinically began to improve. However, he was unable to tolerate weaning of his drain and subsequently had a right frontal ventriculoperitoneal programmable shunt placed. MRI of his head demonstrated features typically seen with hemorrhage involving a CM [Figures and ]. Conventional cerebral angiography revealed no abnormal findings. Unfortunately, despite improvement on MRI [], he has persistent right-sided hyperthesias, dysesthesias, and allodynia consistent with thalamic pain syndrome, also known as Dejerine – Roussy syndrome. Approximately 1 year after his original hemorrhage, he suffered an episode of transient right-sided weakness and worsening of his thalamic pain syndrome. Given his symptoms and CT showing a new slight hyperdensity in the area of his prior bleed the authors suspected he had another small bleed or “ooze” from his suspected cavernoma [Figure and ]. Given this rehemorrhage and critical location it was deemed best to treat this probable CM with stereotactic radiosurgery. Fortunately, this patient has not had any further hemorrhages and has remained relatively stable.