INTRACEREBRAL HEMORRHAGE / VASCULAR MALFORMATIONS

Created 24/02/2022, last revision 22/01/2023

• 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 20-500μm) and are separated with normal brain tissue (unlike cavernous malformations)
• about 2/3 of the lesions have a visible small draining vein
• typical localizations: 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)
  • may cause focal neurological deficit

Diagnostic evaluation

Differential diagnosis

• tumor or metastasis
• subacute ischemia with a hemorrhagic component
• cerebritis
• vascular malformation
  • cerebral cavernous malformation
  • developmental venous anomaly (DVA) – venous angioma
  • AVM

Management

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