[An Unusual Hemisphere Syndrome].

Area of Science:

• Neurology
• Vascular Medicine
• Infectious Diseases

Background:

• Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder affecting blood vessels.
• Neurological complications in HHT can arise from arteriovenous malformations (AVMs).
• Distinguishing between ischemic and infectious neurological events can be challenging.

Observation:

• A patient with HHT presented with transient neurological symptoms suggestive of a transient ischemic attack (TIA).
• The patient subsequently developed a convulsive event and fever, with initial MRI revealing a brain lesion with edema.
• Differential diagnosis considered neoplasia due to the unusual edema, but further tests ruled this out.

Findings:

• Follow-up MRI demonstrated septic embolisms and a brain abscess, indicating an infectious etiology.
• The source of septic embolisms was identified as a pulmonary arteriovenous malformation (PAVM) associated with HHT.
• Neurosurgical intervention and antibiotic therapy led to a favorable clinical outcome.

Implications:

• This case highlights the importance of considering infectious etiologies, specifically brain abscesses, in HHT patients with neurological symptoms.
• Early identification and management of PAVMs in HHT patients are critical to prevent serious neurological complications.
• Integrated neurosurgical and infectious disease management is essential for successful treatment of brain abscesses secondary to HHT.