Cavernous angioma presenting as pregnancy-related seizures

To determine the reason that one-quarter to one-third of epileptic women experienced an increased number of seizures during pregnancy. The cause of this increase is not always clearly understood and the principle emphasis of the literature is on the pregnancy-associated changes of anticonvulsant pharmacokinetics.

Two patients presented with recurrent seizures occurring only during pregnancy. Both had MRI findings typical of cavernous angiomas of the temporal lobe.

In addition to changes in anticonvulsant pharmacokinetics, potential mechanisms underlying the exacerbation of seizures from a vascular malformation during pregnancy include effects of estrogen on temporal structures critically involved in epileptogenesis and changes within the malformation itself secondary to direct actions of estrogen and the hemodynamic changes of pregnancy.

The possibility of an occult lesion such as cavernous angioma should be considered for seizures occurring during pregnancy. Even in the presence of a normal CT scan, an MRI investigation should be pursued, despite the ill-defined fears of MRI in pregnancy.