Electroconvulsive therapy in a patient with a cavernous hemangioma

Intracranial space-occupying lesions are felt to be a relative contraindication to electroconvulsive therapy (ECT), although there have been several reports of safely treating patients with a variety of intracranial vascular malformations. We report a patient with a parietal cavernous hemangioma (CH), whose ECT proceeded without incident. We elected to mitigate the expected increase in blood pressure during the procedure with esmolol, although this precaution may have been unnecessary as CHs are low-flow malformations. While caution is necessary, CHs may represent a relatively minor risk during ECT unless there is evidence of recent hemorrhage.