Presentation
Loss of consciousness and deviation of the labial commissure after three hours of evolution. History of arterial hypertension.
Patient Data
CT brain without contrast shows intraparenchymal hemorrhage (HU +60) at the right basal ganglia region measuring 4.2 x 2.6 cm, which compresses the right lateral ventricle.
At the level of the soft tissues of the scalp, irregularity of the scalp was observed with subgaleal rounded and tubular lesions.
CT angiography of the brain and neck shows multiple subgaleal dilated tortuous varicose vessels predominantly on the left side of the scalp soft tissues, which present avid uptake of contrast medium. These vessels drain into the external jugular veins and produce an irregular appearance of the skin; findings of arterio-venous malformation of the scalp (cirsoid aneurysm).
Persistence of right intraparenchymal hemorrhage without significant changes with respect to the admission study.
3D reconstruction CT angiography shows multiple dilated and tortuous varicose vessels at the level of the soft tissues of the scalp.
Case Discussion
Key learning points:
arteriovenous malformations (AVMs) of the scalp are rare lesions and their origin may be congenital or secondary to trauma
different names have been used to describe these scalp vascular lesions, the most common being cirsoid aneurysm, plexiform angioma, arteriovenous scalp fistula, arteriovenous aneurysm, and arteriovenous malformation
angiotomography plays a key role in treatment planning by tracing the feeding vessels and providing the relationship of the lesion to adjacent structures. However, catheter angiography is the gold standard for diagnosis
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