INTRACEREBRAL HEMORRHAGE / VASCULAR MALFORMATIONS

Capillary telangiectasia

Created 24/02/2022, last revision 14/04/2022

  • the second most common vascular malformation (16-20% of all malformations) after venous angioma (DVA)
  • the lesion is composed of vessels that resemble dilated capillaries (lumen 20-500um) and are separated with normal brain tissue (unlike cavernous malformations)
  • about 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 (within, e.g., Rendu-Osler-Weber syndrome, where AVMs may be present as well) Skin and mucosal manifestations in HHT (Rendu-Osler-Weber)
    • may cause focal neurological deficit

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

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