INTRACEREBRAL HEMORRHAGE / VASCULAR MALFORMATIONS

Capillary telangiectasia

Updated on 06/11/2023, published on 24/02/2022

  • the second most common vascular malformation after venous angioma (DVA) (16-20% of all malformations)
  • the lesion is composed of vessels resembling dilated capillaries (lumen 20-500μm) separated by normal brain tissue (unlike cavernous malformations)
  • approx. 2/3 of the lesions have a visible small draining vein
  • typical locations:
    • pons
    • cerebellum
    • 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 of Hereditary Hemorrhagic Telangiectasia (Rendu-Osler-Weber)
    • may cause focal neurological deficits

Diagnostic evaluation

  • MRI
    • small, usually solitary lesions without mass effect in typical locations (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
Capillary telangiectasia on MR GRE and more sensitive SWI
Brainstem capillary telangiectasia on T2 (left) and T1C+ (right) sequences
Pontine capillary telangiectasia 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/