Zabramski Classification of CCMs Can Predict Future Hemorrhage Risk

Background: Cerebral cavernous malformations (CCMs) are benign vascular lesions. They can be incidental or symptomatic. Symptoms include symptomatic hemorrhage (SH), seizures, and focal neurological deficit (FND). Objective: To study the natural history, presentation, and long-term outcome of CCM based on the Zabramski classification (ZC). Design: Retrospective study from a prospective registry of CCMs encountered in a single U.S. institution between 2015 and 2023. Methods: Based on MRI studies, the ZC type of CCM was determined: Type I – recent hemorrhage – subacute or chronic with a distinct hemosiderin ring, Type II – chronic hemorrhage – blood at different stages, Type III – microhemorrhage – punctate lesion with a hemosiderin rim, and Type IV – no hemorrhage and a tiny lesion. Regarding outcome measures, hemorrhage risk was assessed from diagnosis to the first prospective SH. Follow-up was performed annually for 5 years and then biennial more...