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[Multiple brain abscesses associated with Rendu-Osler-Weber disease: report of two cases]
S Shimokawa1, H Koga, S Nakashima
1Department of Neurosurgery, Institute of Neurosciences, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka 830-0047, Japan.
No to Shinkei = Brain and Nerve
|October 2, 2001
Summary
Multiple brain abscesses can occur in patients with Rendu-Osler-Weber disease and pulmonary arteriovenous fistulas. Prompt treatment with antibiotics and surgical intervention, when appropriate, can lead to successful outcomes.
Area of Science:
- Neurology
- Cardiology
- Genetics
Background:
- Rendu-Osler-Weber disease, also known as hereditary hemorrhagic telangiectasia, is an autosomal dominant disorder.
- Pulmonary arteriovenous fistulas (PAVs) are abnormal connections between pulmonary arteries and veins.
- PAVs are a common complication of Rendu-Osler-Weber disease and can lead to paradoxical emboli.
Observation:
- Two cases of Rendu-Osler-Weber disease with PAVs presenting with multiple brain abscesses are described.
- Case 1: A 57-year-old male with a right parietal lobe abscess treated with surgical drainage and antibiotics; PAV resected.
- Case 2: A 26-year-old female with recurrent frontal and parietal lobe abscesses treated with aspiration and antibiotics; PAV managed conservatively due to extensive shunting.
Findings:
- Brain abscesses are a serious neurological complication associated with PAVs in Rendu-Osler-Weber disease.
- Successful management involves a combination of antibiotics and, in select cases, surgical intervention for both brain abscesses and PAVs.
- Conservative management of PAVs with oral antibiotics may be sufficient in some patients to prevent recurrence.
Implications:
- Highlights the importance of screening for PAVs in Rendu-Osler-Weber patients presenting with neurological symptoms.
- Emphasizes the need for a multidisciplinary approach involving neurologists, cardiologists, and thoracic surgeons for optimal patient care.
- Suggests that tailored treatment strategies for PAVs, considering the extent of vascular involvement, are crucial for preventing recurrent brain abscesses.