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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2022; 80(02): 212-213
DOI: 10.1590/0004-282X-ANP-2021-0389
IMAGES IN NEUROLOGY

Brain abscess and hereditary hemorrhagic telangiectasia

Abscesso cerebral e telangiectasia hemorrágica hereditária
Leonardo Furtado FREITAS 
1   Universidade Federal de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.
,
Márcio Luís DUARTE 
2   Universidade Federal de São Paulo, Departamento de Saúde Baseada em Evidências, São Paulo SP, Brazil.
,
Eduardo Carvalho MIRANDA 
3   Rede MaterDei de Saúde, Departamento de Neurorradiologia, Belo Horizonte MG, Brazil.
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A 58-year-old woman presented speech impairment, mental confusion, and left hemiparesis after being found unconscious. Brain magnetic resonance imaging (MRI) showed pyogenic abscess and multiple vascular malformations in the cerebral hemispheres ([Figures 1] and [2]), resulting in suspicion of Rendu-Osler-Weber disease, i.e., hereditary hemorrhagic telangiectasia (HHT). Chest computed tomography (CT) revealed pulmonary arteriovenous malformation. Ectoscopy detected multiple telangiectasia in the lips, tongue, face, and nasosinusal mucosa ([Figure 3]). HHT is a rare systemic fibrovascular dysplasia (prevalence rate: 1:50000-100000)[1], and brain abscess is an acute and easily forgotten complication that occurs in 1% of patients with considerable mortality, i.e., death rate of 40%[2].

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Figure 1 Brain MRI in axial FLAIR (A), T2-weighted (B), B1000 diffusion (C), and ADC map (D). A pyogenic abscess surrounded by vasogenic edema (arrows) in the right superior temporal gyrus is detected.
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Figure 2 Brain MRI in axial, post-gadolinium volumetric T1 (A to C) and MIP (D) sequences. A pyogenic abscess surrounded by vasogenic edema (arrows) in the right superior temporal gyrus is detected (arrows in A and B). Dashed circles of images A to D highlight multiple tiny vascular malformations in both cerebral hemispheres (capillary malformations and microMAVs), more conspicuous in the MIP sequence.
Zoom
Figure 3 Face ectoscopy (A) and rhinoscopy exam (B); CT of the chest in the lung (C) and soft tissue (D) windows. Other systemic changes in the spectrum of the syndrome: multiple tiny cutaneous telangiectasia on the face, tongue, and labial mucosa (A), as well as on the nasal mucosa (B) and pulmonary vascular malformation compatible with arteriovenous malformation (AVM) (arrows on C and D).

 

Conflict of interest:

There is no conflict of interest to declare.

Authors’ contributions:

LFF, MLD: manuscript composition; ECM: manuscript review.



Address for correspondence

Leonardo Furtado Freitas

Publication History

Received: 19 September 2021

Accepted: 21 October 2021

Article published online:
30 January 2023

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Zoom
Figure 1 Brain MRI in axial FLAIR (A), T2-weighted (B), B1000 diffusion (C), and ADC map (D). A pyogenic abscess surrounded by vasogenic edema (arrows) in the right superior temporal gyrus is detected.
Zoom
Figure 2 Brain MRI in axial, post-gadolinium volumetric T1 (A to C) and MIP (D) sequences. A pyogenic abscess surrounded by vasogenic edema (arrows) in the right superior temporal gyrus is detected (arrows in A and B). Dashed circles of images A to D highlight multiple tiny vascular malformations in both cerebral hemispheres (capillary malformations and microMAVs), more conspicuous in the MIP sequence.
Zoom
Figure 3 Face ectoscopy (A) and rhinoscopy exam (B); CT of the chest in the lung (C) and soft tissue (D) windows. Other systemic changes in the spectrum of the syndrome: multiple tiny cutaneous telangiectasia on the face, tongue, and labial mucosa (A), as well as on the nasal mucosa (B) and pulmonary vascular malformation compatible with arteriovenous malformation (AVM) (arrows on C and D).