Malformación vascular oculta: telangiectasia capilar. Reporte de un caso / Occult vascular malformation: capillary telangiectasia. A case report

RESUMEN: La telangiectasia capilar es una alteración vascular caracterizada por una colección de capilares dilatados que carecen de componente muscular y elástico; se presenta entre el parénquima cerebral normal y constituye el 16 a 20% de todas las malformaciones vasculares intracraneales; ocupa el segundo lugar en frecuencia. Su localización más habitual es la protuberancial; es asintomática, excepto cuando se acompaña de otras malformaciones vasculares o son parte de síndromes de tipo vascular. Su diagnóstico, en casi todos los casos se lo efectúa por los hallazgos incidentales de los estudios de imagen realizados por otras causas. Aunque la telangiectasia capilar pasa desapercibida tanto en la tomografía axial computarizada (TAC) como en la resonancia magnética nuclear (RMN) sin contraste, con el gadolinio endovenoso se observa una lesión hiperintensa, irregular, con apariencia de "cepillo", sin definición individual de los vasos. Se presenta el caso de un paciente de 1 año 2 meses de edad, previamente sano, que ingresó con sintomatología de meningoencefalitis y estatus convulsivo. Se realizó los estudios de resonancia magnética simple, contrastada y angiorresonancia, en los cuales se identificó, de manera incidental, telangiectasia capilar protuberancial, visible únicamente en el estudio contrastado. Se realiza una revisión bibliográfica de dicha patología.Palabras claves: telangiectasia capilar, malformaciones vasculares, resonancia magnética.

ABSTRACT: Capillary telangiectasia is defined as a collection of dilated capillary vessels, without muscular and elastic components, situated within otherwise normal brain parenchyma and accounts for 16-20% of all intracranial vascular malformations, representing the second most common one. It is most frequently found in the pons and it has an asymptomatic natural course, except when the lesions are associated with other vascular malformations or are part of a vascular syndrome. Most are diagnosed as incidental findings in imaging studies performed for other causes. Capillary Telangiectasia is invisible in Computed Tomography and Magnetic Resonance without contrast, however, after intravenous administration of Gadolinium, it will present as a hyperintense, irregular, "brush-like" enhancing lesion, without individual definition of the vessels. We describe the case of a 1 year and 2 months old patient, previously healthy, who presented with signs of meningo-encephalitis and epileptic status. A Magnetic Resonance Image with and without contrast and an angioresonance were performed, in which, as an incidental finding, a pontine Capillary Telangiectasia, visible only in contrasted images was found. A bibliographic review of said pathology is presented in this article.Keywords:capillary telangiectasia, vascular malformations, magnetic resonance.

The diagnostic value of susceptibility weighted imaging in intracranial capillary telangiectasia / 实用放射学杂志

Objective To assess the diagnostic value of susceptibility weighted imaging in intracranial capillary telangiectasia. Methods Clinical and imaging data of 1 3 cases with pathologically proved intracranial telangiectasia were collected.All 1 3 patients were examined with conventional MRI and SWI scanning,five patients were checked with MRA while other six cases were examined by CT scanner,and the results were compared.Results All 13 patients had multiple lesions and a total of 176 lesions were detected by SWI,exhibiting hypointense with possiblely punctate hyperintense in the center .Fifty-two lesions were detected by T1 weighted imaging;105 lesions were detected by T2 weighted imaging;112 lesions were detected by fluid attenuated inversion recovery;69 lesions were detected by diffusion weighted imaging;6 9 lesions were detected by apparent diffusion coefficient.Six cases underwent CT scanning, and one showed multiple low density while the remaining five cases did not find any abnormalities.No cerebral vascular malformation was found in five cases scanned by MRA.The lesions showed round or oval shape,ranging from 3 mm to 17mm in diameter.Among them,98 lesions were located in the pons,39 in cerebellum,23 in cortex,10 in basal ganglia,6 in thalamus.Conclusion SWI is the sensitive sequence to detect intracranial capillary telangiectasia.SWI could be used as the preferred imaging method for intracranial capillary telangiectasia.

Capillary Telangiectasia of the Posterior Fossa Presenting with Repeated Cerebellar Hemorrhage

Hemorrhage due to capillary telangiectasia is rare. We report a case of capillary telangiectasia presenting with repeated cerebellar hemorrhage in a 38-year-old male. To our knowledge this is the first case of repeated cerebellar hemorrhage from the capillary telangiectasia. At the first operation, we removed hematoma only, but rebleeding occurred repeatedly in the same area. Finally, we evacuated the recurrent hematoma and vascular mass of capillary telangiectasia at the second operation under surgical microscope. Based on the findings of this case and a review of the literature, we conclude that capillary telangiectasia can be the cause of the massive repeated hemorrhage.