INTRACEREBRAL HEMORRHAGE / VASCULAR MALFORMATIONS

Created 24/02/2022, last revision 16/08/2023

• 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) 
  • may cause focal neurological deficits

• MRI
  • small, usually solitary lesions without mass effect
    • typical localization:  pons, cerebellum, and spinal cord
  • T1: iso- to a hypointense lesion
  • T1C+: enhancing lesion, draining veins may be seen in large telangiectasias
    
  • T2: normal or only slightly hyperintense
  • GRE/SWI: hypointense (low signal caused by slowed flow, not hemorrhage) [Castillo, 2001]
• CT – usually negative or shows a nonspecific small enhancing lesion
• DSA – negative

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

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