An indolent headache revealing a megadolicho-diffuse vascular malformation

• Published in: Arquivos de neuro-psiquiatria Vol. 72; no. 9; p. 741
• Main Authors: Cruzeiro, Marcelo Maroco, Resende, Hugo Almeida Chaves de, Franco, Igor de Assis, Pires, Leopoldo Antônio, Vale, Thiago Cardoso
• Format: Journal Article
• Language: English
• Published: Brazil Academia Brasileira de Neurologia (ABNEURO) 01.09.2014
• Subjects: Basilar Artery - abnormalities; Carotid Artery, Internal - abnormalities; Headache - etiology; Humans; Magnetic Resonance Angiography; Male; Middle Aged; Vascular Malformations - complications
• ISSN: 0004-282X; 1678-4227; 1678-4227; 0004-282X
• DOI: 10.1590/0004-282X20140103

A 61-year-old hypertensive man sought neurologic consultation due to a 20-year history of a right-sided dull headache of a low frequency, mild intensity, and without additional features. Headache responded to common analgesics and was not bothersome until his brother was diagnosed with cerebral aneurysm. He then pursued a brain vascular neuroimaging study. His brain magnetic resonance angiography revealed megadolicho-vascular malformation of the intracranial part of the internal carotid arteries and some of its branches and of the basilar artery (Figure). Megadolicho-diffuse vascular malformation, involving both anterior and posterior circulations, is exceedingly rare and there are only a handful of published cases. Most cases are asymptomatic. When symptoms are present, they can be divided into ischemic, hemorrhagic, and mass effect. Reported manifestations include cerebellar dysfunction, ischemic stroke, trigeminal neuralgia, and brainstem compression syndrome. Multiple pathophysiological processes might contribute to the development of such arterial ectasia vessels such as systemic arterial hypertension associated with atherosclerosis, what might have occurred in our patient[1,2,3,4].