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Recurrence of brain abscess associated with asymptomatic arteriovenous malformation of the lung
M Caroli1, C Arienta, P M Rampini
1Neurosurgical Clinic, University of Milan, Italy.
Abstract:
On the basis of the data provided by literature the majority of patients with an arteriovenous malformation of the lung who develop a brain abscess suffer from hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber disease. Only nine cases of brain abscesses in which the arteriovenous malformation of the lung was isolated have been described and in all of these, clinical signs and/or alterations in the laboratory data were detected which can be attributed to the arteriovenous malformation itself. The case taken in this article would seem to be the first case of a recurrent brain abscess in a patient not suffering from Rendu-Osler-Weber with a completely asymptomatic arteriovenous malformation of the lung, both from the clinical point of view and from laboratory data. The authors stress the appropriacy of an angiographic pulmonary study in cases of recurrent brain abscesses, even where the chest X-ray has been negative.
Insights
Brain abscesses can occur with asymptomatic lung arteriovenous malformations, even without Rendu-Osler-Weber disease. Pulmonary angiography is recommended for recurrent brain abscesses, especially with negative chest X-rays.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- Arteriovenous malformations (AVMs) of the lung are associated with brain abscesses, primarily in patients with hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber disease.
- Literature review indicates only nine reported cases of isolated pulmonary AVMs causing brain abscesses, all with detectable clinical or laboratory signs of the AVM.
Observation:
- This report details the first case of recurrent brain abscess in a patient without HHT.
- The patient presented with a pulmonary AVM that was clinically and laboratorially asymptomatic.
Findings:
- The case highlights a potential link between asymptomatic pulmonary AVMs and recurrent brain abscesses in non-HHT patients.
- This challenges the established understanding that pulmonary AVMs causing brain abscesses are always symptomatic.
Implications:
- Pulmonary angiography should be considered in the diagnostic workup of recurrent brain abscesses, even when chest X-rays are normal.
- This finding may necessitate a broader screening approach for pulmonary AVMs in patients with unexplained recurrent brain abscesses.