Clinically Isolated Syndrome and Frontal Lobe Arteriovenous Malformation Presenting With Behavior Issues

Area of Science:

• Neurology
• Neuroscience
• Pediatrics

Background:

• Brain arteriovenous malformations (AVMs) are rare vascular anomalies with a prevalence of 0.14%–0.6%.
• Many brain AVMs remain asymptomatic, but hemorrhage is the most common presentation.
• Psychiatric symptoms can sometimes be the initial manifestation of neurological conditions.

Observation:

• A 14-year-old girl presented with behavioral issues and hallucinations, initially diagnosed with schizophrenia and bipolar disorder.
• Further evaluation at a children's hospital, including neuroimaging, revealed a frontal lobe arteriovenous malformation.
• This case highlights a clinically isolated syndrome presentation.

Findings:

• Frontal lobe arteriovenous malformations can manifest with psychological and behavioral symptoms, mimicking primary psychiatric disorders.
• Neuroimaging techniques like CT and MRI are essential for diagnosing brain AVMs.
• Differential diagnosis should include acute demyelinating syndromes.

Implications:

• This case underscores the importance of considering organic neurological causes in adolescent psychiatric presentations.
• Accurate diagnosis of brain AVMs is critical to prevent potential complications like hemorrhage.
• Enhanced awareness among clinicians can improve early detection and management of AVMs presenting atypically.