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

Abstract

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.

Giant Calcified Thrombosed Varices Secondary to a Pial Arteriovenous Fistula Associated With Hereditary Hemorrhagic Telangiectasia

“…1,4,[15][16][17]20,21) Usually, only disconnection of the feeding artery is sufficient to decompress the lesion because the varices might shrink and immediately lose the mass effect. 7) However, if the varices have a hard wall and thrombosed component, only disconnection of the feeding artery might not reduce the volume.…”

“…7) However, if the varices have a hard wall and thrombosed component, only disconnection of the feeding artery might not reduce the volume. Although some cases of large varices associated with AVF have been reported in anecdotal case series, 1,4,[15][16][17]20,21) the treatment of such cases has not been well described.…”