Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Case Report

CT-negative Subarachnoid Hemorrhage Caused by Telangiectasia: A Case Report

Author(s): Xin Zhang, Jing Mang , Xiaohua Shi , Lei Xu* and Zhongxin Xu*

Volume 17, Issue 10, 2021

Published on: 13 July, 2021

Article ID: e080621193971 Pages: 4

DOI: 10.2174/1573405617666210608163746

Price: $65

Abstract

Introduction: At present, the mechanism of telangiectasia is unknown, but some evidence suggests that it may be related to genetic abnormalities. Telangiectasia may lead to bleeding of multiple sites. CT-negative subarachnoid hemorrhage is rare, which is mostly related to hemorrhage with a little amount of bleeding. CT-negative subarachnoid hemorrhage due to telangiectasia has not been reported.

Case Report: In this case report, the patient experienced severe headache with nausea, vomiting, and blurred vision for 12 days, and had a history of hypertension. Physical examination revealed a clear state of mind, normal speech, normal limb muscle strength, 2 transverse fingers of neck stiffness, and negative bilateral Babinski signs. Brain CT, MRI, MRA, and MRV showed no obvious abnormalities. SWI suggested the possibility of capillary dilation. The cerebrospinal fluid was pale yellow in appearance after lumbar puncture.

Diagnosis: The patient was diagnosed with subarachnoid hemorrhage (SAH) and capillary dilatation.

Interventions: Therapeutic management of blood pressure and brain edema was started.

Conclusion: Lumbar puncture should be performed when subarachnoid hemorrhage is clinically suspected and CT is negative. While searching for the cause of subarachnoid hemorrhage, the presence of telangiectasia should be ascertained.

Keywords: Subarachnoid hemorrhage, telangiectasia, capillary dilatation, lumbar puncture, CT, SWI.

Graphical Abstract
[1]
Pau H, Carney AS, Murty GE. Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): Otorhinolaryngological manifestations. Clin Otolaryngol Allied Sci 2001; 26(2): 93-8.
[http://dx.doi.org/10.1046/j.1365-2273.2001.00442.x] [PMID: 11309047]
[2]
Dakeishi M, Shioya T, Wada Y, et al. Genetic epidemiology of hereditary hemorrhagic telangiectasia in a local community in the northern part of Japan. Hum Mutat 2002; 19(2): 140-8.
[http://dx.doi.org/10.1002/humu.10026] [PMID: 11793473]
[3]
AAssar OS, Friedman CM, White RI Jr. The natural history of epistaxis in hereditary hemorrhagic telangiectasia. Laryngoscope 1991; 101(9): 977-80.
[http://dx.doi.org/10.1288/00005537-199109000-00008] [PMID: 1886446]
[4]
Román G, Fisher M, Perl DP, Poser CM. Neurological manifestations of hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease): Report of 2 cases and review of the literature. Ann Neurol 1978; 4(2): 130-44.
[http://dx.doi.org/10.1002/ana.410040207] [PMID: 707984]
[5]
Maher CO, Piepgras DG, Brown RD Jr, Friedman JA, Pollock BE. Cerebrovascular manifestations in 321 cases of hereditary hemorrhagic telangiectasia. Stroke 2001; 32(4): 877-82.
[http://dx.doi.org/10.1161/01.STR.32.4.877] [PMID: 11283386]
[6]
White RJ, Kernohan JW, Wood MW. A study of fifty intracranial vascular tumors found incidentally at necropsy. J Neuropathol Exp Neurol 1958; 17(2): 392-8.
[http://dx.doi.org/10.1097/00005072-195804000-00022] [PMID: 13525999]
[7]
Russell DS, Rubinstein W, Baltimore Md. In Pathology of Tumours of the Nervous System. (4th ed).. 116-45.
[8]
McCormick WF, Hardman JM, Boulter TR. Vascular malformations (“angiomas”) of the brain, with special reference to those occurring in the posterior fossa. J Neurosurg 1968; 28(3): 241-51.
[http://dx.doi.org/10.3171/jns.1968.28.3.0241] [PMID: 5643915]
[9]
Brinjikji W, Iyer VN, Yamaki V, et al. Neurovascular manifestations of hereditary hemorrhagic telangiectasia: A consecutive series of 376 patients during 15 years. AJNR Am J Neuroradiol 2016; 37(8): 1479-86.
[http://dx.doi.org/10.3174/ajnr.A4762] [PMID: 27012295]
[10]
Rattani A, Dewan MC, Hannig V, Naftel RP, Wellons JC III, Jordan LC. Cerebral hemorrhage in monozygotic twins with hereditary hemorrhagic telangiectasia: Case report and hemorrhagic risk evaluation. J Neurosurg Pediatr 2017; 20(2): 164-9.
[http://dx.doi.org/10.3171/2017.3.PEDS16587] [PMID: 28524787]
[11]
Matsubara S, Mandzia JL, ter Brugge K, et al. Angiographic and clinical characteristics of patients with cerebral arteriovenous malformations associated with hereditary hemorrhagic telangiectasia. AJNR Am J Neuroradi 2000; 21(6): 1016-20.
[12]
Steele JG, Nath PU, Burn J, Porteous ME. An association between migrainous aura and hereditary haemorrhagic telangiectasia. Headache 1993; 33(3): 145-8.
[http://dx.doi.org/10.1111/j.1526-4610.1993.hed3303145.x] [PMID: 8486513]
[13]
Grobelny TJ. Brain aneurysms: Epidemiology, treatment options, and milestones of endovascular treatment evolution. Dis Mon 2011; 57(10): 647-55.
[http://dx.doi.org/10.1016/j.disamonth.2011.08.022] [PMID: 22036120]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy