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Occult arteriovenous malformation of the brainstem simulating multiple sclerosis
Neurology
|July 1, 1981
Summary
Occult arteriovenous malformations (AVMs) in the brainstem can mimic multiple sclerosis for decades. Computed tomography (CT) is crucial for diagnosing these AVMs when arteriograms are normal.
Area of Science:
- Neurology
- Neuroradiology
- Vascular Malformations
Background:
- Arteriovenous malformations (AVMs) can present with diverse neurological symptoms.
- Misdiagnosis of AVMs can lead to delayed or incorrect treatment.
- Fluctuating neurological signs in the brainstem can be challenging to diagnose.
Observation:
- A patient with a 20-year history of fluctuating brainstem symptoms was initially diagnosed with multiple sclerosis.
- Computed tomography (CT) revealed a lesion suggestive of a vascular malformation bridging the subarachnoid space.
- Arteriography failed to detect the arteriovenous malformation, classifying it as angiographically occult.
Findings:
- CT imaging demonstrated a high-density, multiform appearance of the lesion, enhancing with contrast.
- The lesion was confirmed to be an occult arteriovenous malformation of the brainstem and cerebellum.
- The diagnostic challenge arose from the lesion's occult nature on angiography despite suggestive CT findings.
Implications:
- CT is vital for diagnosing occult brainstem AVMs, especially with fluctuating neurological symptoms.
- Clinical suspicion is key when neurological deficits localize to the brainstem and fluctuate.
- Surgical removal of brainstem AVMs is hazardous; biopsy may confirm diagnosis, but conservative management is often preferred due to the chronic, benign course.