The Clinical and Pathological Spectrum of Brain-stem Vascular Malformations

Brain Stem Vascular Malformation Simulating a Hemorrhagic Metastasis: Report of a Case with Pathologic Correlation

“…Neurologic signs and symptoms are often multiple, episodic and progressive. The wax ing and waning course may be indistinguish able from that of multiple sclerosis [ 12], CCT generally shows calcification within a brain stem lesion that displays relatively little mass effect and shows little contrast enhancement [15], These lesions have, however, been con fused with that of a pontine glioma, resulting in unnecessary radiation [10], Our case de scribed above is of special interest from sev eral aspects. She had a known diagnosis of metastatic breast carcinoma and no previous episodes suggestive of brain stem pathology.…”

“…Of those in the posterior fossa, 2% of the total involved the brain stem and 5 % of the total were cere bellar. Vascular malformations of the brain stem include arteriovenous malformations, capillary telangiectasias, venous angiomas, cavernous hemangiomas and varices and are characterized by a spectrum of pathological and clinical findings [5], Cavernous heman gioma and arteriovenous malformations pro duce symptoms more commonly than do te langiectasias [12]. Although the clinical ex pressions of these lesions range from no symptoms to sudden fatal brain stem hemor rhage, a large percentage of patients will have a positive history spanning several years [ 15].…”

“…Brain stem vascular malformations may be an incidental postmortem finding [5], have an insidious onset with slow progres sion [12], or manifest themselves as a cata strophic inlraparenchymal or subarachnoid hemorrhage [8]. We report a 65-year-old pa tient with known breast carcinoma who pre sented with a 4-day history of progressive brain stem symptomatology.…”

Lateral Tegmental Pontine Haemorrhage due to Vascular Malformations

“…These include relative youth, the absence of pre-existing hypertension, subacute onset with progressive development of neurological signs over several days, and recurrent haemorrhage at the same site [4,5], Angiography remains an essential diagnostic tool, for even if the malformation is not detected, associated intracranial aneurysms have been reported in about 1 of 15 cases [7], Magnetic resonance angiography may re place conventional angiography in the future. This tech nique has been shown to provide accurate imaging of the carotid artery in the neck [8], and the quality of intrace rebral angiograms is improving dramatically [9].…”

“…Brainstem haemorrhage in an atypical site, espe cially in young patients without pre-existing hyperten sion, raises the possibility of an underlying vascular malformation [4,5], Accurate diagnosis is important, as haemorrhage may be recurrent, and viable therapeutic modalities, including conventional surgery and stereo tactic radiosurgery, are available. Whilst angiography is the traditional diagnostic tool, magnetic resonance imaging (MRI) represents a sensitive, non-invasive al ternative.…”