Neurological involvement in hereditary hemorrhagic telangiectasia

• Published in: Journal of neuroradiology 2016-07, Vol.43 (4), p.236-245
• Main Authors: Labeyrie, Paul-Emile, Courthéoux, Patrick, Babin, Emmanuel, Bergot, Emmanuel, Touzé, Emmanuel, Pelage, Jean-Pierre
• Format: Article
• Language: English
• Subjects: Adult; Arteriovenous malformation; Brain - blood supply; Brain - diagnostic imaging; Brain - pathology; Cerebral Angiography; Epistaxis; Female; Genetic disorders; Hereditary hemorrhagic telangiectasia; Humans; Interventional radiology; Intracranial Arteriovenous Malformations - complications; Intracranial Arteriovenous Malformations - diagnostic imaging; Intracranial Arteriovenous Malformations - pathology; Life Sciences; Neuroradiology; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - pathology; Radiology; Spinal Cord - blood supply; Spinal Cord - diagnostic imaging; Spinal Cord - pathology; Stroke; Telangiectasia, Hereditary Hemorrhagic - complications; Telangiectasia, Hereditary Hemorrhagic - diagnostic imaging; Telangiectasia, Hereditary Hemorrhagic - pathology; Tomography, X-Ray Computed
• ISSN: 0150-9861
• DOI: 10.1016/j.neurad.2016.02.005

Summary Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by epistaxis, telangiectases, and multi-organ vascular dysplasia. Head and neck localizations of HHT are recurrent, frequent associated with serious complications. The aim of this study was to describe the clinical and imaging patterns of neurological involvement in HHT and to discuss the role of interventional radiology in the management of HHT patients. Based on a multidisciplinary experience of twenty years at our center, we report here the different aspects of neurological involvement of HHT. Depending on the genetic type of the disease, vascular abnormalities may affect different organs. The knowledge of neurological involvement according to specific localization of HHT makes detection easier. As cerebral or spinal arteriovenous fistula may be present in patients with epistaxis or pulmonary arteriovenous malformations (PAVMs), radiologists should be able to detect high-risk lesions and prevent related complications. Finally, we review indications and techniques of embolization for hemorrhagic lesions and emphasize that endovascular therapies are very effective and safe in experienced hands. Head and neck imaging is commonly used for the diagnosis of HHT. Imaging plays also a key role for patient evaluation before treatment as pluridisciplinary management is needed.