A Unique Case of LMN 7 <superscript>th</superscript> Nerve Palsy Due to a Single Pontine Cavernoma.

A 36-year-old previously fit and well-right-handed patient came in with complaints of right facial droop along with mild slurring of her speech and right lower limb paresthesia for 4 days. She had a right-sided LMN 7th nerve palsy along with brisk reflexes on the right side. An urgent MRI with contrast was performed, which showed evidence of an isolated small cavernoma in the dorsal pons along the right facial colliculus, which had evidence of small-volume bleeding [Figure 1], [Figure 2], [Figure 3]. She was discussed at the regional neurovascular meeting, and the lesion was thought to be not amenable for stereotactic radiosurgery or open surgery. Upon follow-up, her symptoms had completely resolved.{Figure 1}{Figure 2}{Figure 3}

Cavernous malformations are the most prevalent type of vascular malformation in the brain, with an incidence of 0.4–0.5% and a prevalence of 0.6/100,000 inhabitants. Patients with brainstem cavernous malformations may present with cranial nerve deficits, sensory changes, headache, motor deficits of the extremities, diplopia, ataxia, and vertigo. Cranial nerve deficits are the most common early clinical presentation.[[1]] Brainstem cavernous malformations have a 5-year estimated risk of intracranial hemorrhage of 8% and 30.8% when presenting without or with intracranial hemorrhage or focal neurological deficit, respectively.[[2]]

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