Unusual Giant Cerebral Venous Varix Associated With Brain Abscess: Variant of Hereditary Hemorrhagic Telangiectasia Case Report

• Published in: Neurologia medico-chirurgica Vol. 47; no. 2; pp. 74 - 78
• Main Authors: OISHI, Makoto, SASAKI, Osamu, NAKAZATO, Shinji, SUZUKI, Kenji, KITAZAWA, Keiko, TAKAO, Tetsuro, KOIKE, Tetsuo
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 2007
• Subjects: Adult; arteriovenous fistula; arteriovenous malformation; Brain - blood supply; brain abscess; Brain Abscess - complications; Central Nervous System Vascular Malformations - etiology; cerebral venous varix; hereditary hemorrhagic telangiectasia; Humans; Intracranial Arteriovenous Malformations - etiology; Male; Telangiectasia, Hereditary Hemorrhagic - complications; Varicose Veins - etiology
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.47.74

A 35-year-old man suffered secondary generalized tonic-clonic convulsions due to a large brain abscess. Neuroimaging incidentally revealed another tumor-like lesion. Cerebral angiography confirmed that the lesion was an unusual giant venous varix associated with a high-flow pial arteriovenous fistula (AVF) and showed one more small arteriovenous malformation (AVM). Pulmonary AVF, which can cause brain abscess, was also detected. Surgical ligation of the AVF and removal of the small AVM via individual craniotomies resulted in successful extirpation of the cerebrovascular malformations. Although the typical mucocutaneous symptoms were absent in this patient, the combination of arteriovenous anomalies was highly suggestive of hereditary hemorrhagic telangiectasia.