Author: Alexander Soto, MD, MPH
Co Author #1: Kimberly Burbank, MD
Co Author #2: Joshua Goldman, MD, MBA
Senior Editor: Justin Mark Young, MD, FAMSSM
Editor: Katlyn Elliott, MD

Patient Presentation:
A 20-year-old male collegiate athlete with a known right occipital cavernous malformation presented with a two-month history of progressive nausea that was initially exertional and later occurred at rest and following meals. Initially, the nausea occurred during physical activity but gradually became triggered by exercise and, on occasion occurred both at rest and following meals. Over the three weeks prior to presentation, he experienced two episodes of nocturnal vomiting and he recalled an exacerbation during a volleyball tournament rally the preceding weekend. He denied recent head trauma or falls, as well as neurological symptoms including diplopia, dysgeusia, anosmia, focal weakness or numbness, dysarthria, photophobia, or phonophobia. He also denied systemic symptoms such as fever, chills, or diarrhea. He reported maintaining adequate oral intake, though he noted increased sensitivity to certain odors.

History:
Past medical history was notable for infectious mononucleosis in October 2023, during which his cavernous malformation was incidentally identified on imaging and has subsequently been followed with surveillance imaging.

Physical Exam:
Temperature was 97.1 °F, heart rate 47 bpm, and blood pressure 132/74 mmHg. The patient was well-appearing and in no acute distress.
HEENT examination demonstrated pupils equal, round, and reactive to light with intact extraocular movements. Oropharynx was clear.
Cardiovascular examination revealed regular rate and rhythm without murmurs, rubs, or gallops.
Pulmonary examination demonstrated clear breath sounds bilaterally without wheezes, rales, or rhonchi. Abdomen was soft, non-tender, and non-distended.
Neurologic examination demonstrated the patient was alert and oriented to person, place, and time. Cranial nerves II-XII were grossly intact. Muscle strength was 5/5 throughout all extremities with intact sensation and normal cerebellar testing.
Psychiatric examination demonstrated appropriate affect and behavior.

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