Q)  What is the natural history of cerebral cavernous malformations (CCMs)?

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A) The natural history of CCMS depend on the location and whether CCM causes any problems. If CCM is in non-brainstem location, the annual risk of ICH < 1%. A meta-analysis of the clinical course of untreated CCMs shows that brainstem CCM location and CCM presentation with ICH or focal neurological deficit (FND) are independently associated with ICH within 5 years.  Age, sex and CCM multiplicity are not independent prognostic significance. The risk of ICH declines over time in people initially presenting with ICH or FND. Annual risk of ICH in the first year of follow up was 6.2% and was down to 2% in the fifth year.   

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Reference

1. Horne MA, Flemming KD, Su IC, et al. Clinical course of untreated cerebral cavernous malformations: a meta-analysis of individual patient data. Lancet Neurol. 2016;15(2):166-173.