[Giant arteriovenous angiomas of the brain with scant clinical manifestations]

Two patients are described with large intracranial arteriovenous angioma with minimal neurological symptoms. The first patient suffered from repeated right fronto-temporal headache. Migraine was diagnosed and he was treated with analgesic drugs. We carried out scintigraphic investigation and computerized tomography of the brain. The results of these examinations suggested the presence of large brain lesion (tumour or vascular malformation). Bilateral carotid angiography and aortic arch angiography were done in this patient. A large arteriovenous angioma was discovered in the right occipital area. The second patient complained of throbbing headaches. A bruit could be heard over the left eye which was exophthalmic. Angiograms showed a carotid-cavernous fistula on the left side and a large angioma in the fronto-parietal area. The angioma was clinically "silent". It diminished the symptoms of the carotid-cavernous fistula through the uptake of blood. Both patients were regarded as unsuitable for surgery. The reasons were the great dimension of these angiomas and a large number of supplying arteries.