Challenging differential diagnosis, Unusual setting of medical care, Rare disease
Ioan Alexandru Florian, Laura Popovici, Teodora Larisa Timis, Ioan Stefan Florian, Ioana Berindan-Neagoe
Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
Am J Case Rep 2020; 21:e922872
Available online: 2020-04-02
Brain arteriovenous malformations (AVMs) are benign intracranial vascular anomalies that, under certain circumstances, may become life-threatening. Diffuse calcifications found in the vessel walls, interposing tissue or adjacent cerebral parenchyma are not uncommon, however, intense calcifications of AVMs that render them into veritable “brain stones” are scarcely reported in the literature and a genuine neurosurgical nightmare.
CASE REPORT: A 55 years-old male patient lacking any personal history of serious morbidities or surgical interventions was referred to our department for several epileptic seizures and severe chronic headache in the parieto-occipital region. Upon clinical examination, the patient was aware, right-handed, and had no motor or sensory deficits. Computed tomography angiography scan showed a large densely calcified frontal AVM. The patient was subjected to neurosurgical removal of the lesion and was discharged a week later with a minor motor deficit of the left arm.
CONCLUSIONS: Intracranial AVMs are a rare pathology, but a genuine microsurgical trial. The difficulty level soars when the malformed vessels become atherosclerotic and calcified, rendering bipolar ligation or permanent clipping unfeasible. An incomplete resection in the case of a highly calcified lesion can only result in an uncontrollable hemorrhage.
Keywords: Arteriovenous Malformations, Calcinosis, Neurosurgical Procedures, Seizures