INTRACEREBRAL HEMORRHAGE / VASCULAR MALFORMATIONS

Capillary telangiectasia

Created 24/02/2022, last revision 26/05/2023

  • the second most common vascular malformation after venous angioma (DVA) (16-20% of all malformations)
  • the lesion is composed of vessels that resemble dilated capillaries (lumen 20-500μm) and are separated by normal brain tissue (unlike cavernous malformations)
  • approx. 2/3 of the lesions have a visible small draining vein
  • typical localization: pons, cerebellum, and spinal cord
  • the vast majority of telangiectasias are asymptomatic (incidental finding on MRI)
    • low potential for hemorrhage unless multiple (e.g., in Rendu-Osler-Weber syndrome, where AVMs may also be present)  Skin and mucosal manifestations in HHT (Rendu-Osler-Weber)
    • may cause focal neurological deficits

Diagnostic evaluation

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Capillary telangiectasia on MR GRE and more sensitive SWI
Brainstem capillary telangiectasia on T2 (left) and T1C+ (right) sequencies
Capillary teleangiectasia with brush-like pattern (T1C+)

Differential diagnosis

Management

  • usually conservative approach
    • the lesion is difficult to access
    • almost always asymptomatic
  • MRI follow-up is not required if the imaging is typical

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Capillary telangiectasia
link: https://www.stroke-manual.com/capillary-telangiectasia/