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Updated: Jun 13, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
[Brain abscess as the first clinical manifestation of isolated pulmonary arteriovenous malformation without
A Drouet1, F Le Moigne, A Donat
1Service de neurologie, HIA Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 3, France. drouetalain@yahoo.fr
Introduction:
Brain abscesses occur in 5 to 13 % of patients with pulmonary arteriovenous malformation (PAVM), more often present in Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia (HHT).
Case Report:
A 51-year-old man with a history of transient Parinaud syndrome at 37 years complained of headache for 2 months before acute onset of a left cerebellar syndrome without fever. CT-scan and MRI of the head revealed a heterogeneous left cerebellar lesion. A brain abscess was drained and all signs resolved. CT-scan of the chest revealed a left lingual PAVM; occlusion was incomplete after coil embolization. He had no feature of HHT and no mutation in ENG and ACVRL1 genes. A second embolization was performed 5 months later, but the malformation was not occluded at 6 months.
Discussion:
We report the seventh case of PAVM complicated by a cerebellar abscess. The right to left shunt in PAVM results in hypoxemia, secondary polycythemia and paradoxical embolization of infective organisms bypassing the pulmonary filter.
Conclusion:
Combining different MRI techniques (in particular diffusion and proton MR spectroscopy) provides invaluable data for the diagnosis of brain abscess. Careful search for PAVM must be undertaken, particularly in adults with cryptogenic abscess, to avoid further abscess formation or stroke.
Insights
Pulmonary arteriovenous malformations (PAVMs) can lead to brain abscesses due to right-to-left shunting. Early detection and treatment of PAVMs are crucial to prevent neurological complications like cerebellar abscesses.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Brain abscesses are a known complication in 5-13% of patients with pulmonary arteriovenous malformations (PAVMs).
- PAVMs are often associated with Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia (HHT).
Observation:
- A 51-year-old man presented with headache and cerebellar syndrome, diagnosed as a cerebellar abscess.
- Imaging revealed a left lingual PAVM, which was treated with incomplete embolization.
- The patient had no HHT features or genetic mutations in ENG and ACVRL1.
Findings:
- This case represents the seventh reported instance of PAVM complicated by a cerebellar abscess.
- PAVMs facilitate paradoxical embolization of infective organisms and hypoxemia, leading to secondary polycythemia.
- Advanced MRI techniques, including diffusion and MR spectroscopy, are vital for diagnosing brain abscesses.
Implications:
- A thorough investigation for PAVMs is essential in adult patients with cryptogenic brain abscesses.
- Prompt identification and management of PAVMs can prevent recurrent brain abscesses and strokes.
- This case underscores the importance of considering PAVMs in the differential diagnosis of unexplained neurological deficits.
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