Multiple Cerebral Cavernous Malformation: An Unusual Cause of Vertigo

Cerebral cavernous malformation (CM) is a rare benign vascular lesion of the brain, accounting for only 0.3-0.5% incidence in the population. Among them, only a small portion of the patients have multiple lesions (3-33%). While most lesions are asymptomatic, some patients present with seizures and hemorrhagic events. We present an atypical case of multiple cerebral CM in a patient who presented with vertigo. He did not have apparent neurological signs and symptoms until it was detected through imaging studies. His MRI showed multiple CM, with the largest lesion located in the cerebellopontine angle. A neurological consult was obtained and the patient opted for conservative treatment. He was discharged well on medications and was under active monitoring by both the neurosurgery and otorhinolaryngology teams. Intracranial cavernoma can present as vertigo without classic neurological manifestations. Any atypical presentations should alert the physician to perform further imaging to rule out sinister causes in the brain. To date, there is no reported case of intracranial cavernoma presenting as vertigo in the literature.