A 22-year-old man presented with a 5-year history of focal seizures and a pulsatile bump on the forehead (figure, A; video on the Neurology® Web site at Neurology.org). He had subtle right hemiparesis with facial palsy, Mini-Mental State Examination score of 22/30, and audible bruit on forehead swelling, suggesting cerebral proliferative angiopathy (CPA). This condition differs from arteriovenous malformation in in that hemorrhages are uncommon; it has a typically large size, with normal brain parenchyma between vascular spaces (figure, B).1 There are multiple arterial feeders (figure, C) with prominent draining veins (figure, D).1,2 Embolization or surgical resections are not usually possible with a CPA diagnosis.1
(A) Pulsatile swelling on the forehead. (B) T2-weighted axial image shows multiple flow voids in the left frontal and parietal area with intervening normal brain tissue and pressure on ipsilateral lateral ventricle. (C) CT angiogram shows extensive abnormal vascular network with multiple feeders including anterior and middle cerebral arteries. (D) Contrast MRI shows prominent sinuses and draining veins communicating with the forehead swelling.
Footnotes
Supplemental data at Neurology.org
Author contributions: Dr. Geeta Anjum Khwaja: drafting the manuscript, study concept, supervision and coordination. Dr. Vikram Bohra: drafting the manuscript, study design, literature search. Dr. Ashish Duggal: interpretation of data, acquisition of data. Dr. Abhilekh Srivastava: interpretation of data, acquisition of data. Dr. Neera Chaudhry: interpretation of data, study supervision.
Study funding: No targeted funding reported.
Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
- © 2015 American Academy of Neurology
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