Cerebrofacial vascular disease

Cerebrofacial vascular metameric syndrome associated with Moyamoya syndrome: a rare case report

INTRODUCTION

Neural crest and mesoderm cell dysfunction of certain metameric level result in vascular malformations, i.e., cerebrofacial arteriovenous metameric syndrome (CAMS) and cerebrofacial venous metameric syndrome (CVMS). Moyamoya disease is a progressive steno-occlusive disease in the terminal portions of the bilateral internal carotid artery. The patient in this case report was a child with cerebrofacial vascular metameric syndrome, associated with moyamoya syndrome.

CASE REPORT

Child, 7 months old, female, admitted to the emergency department with seizures, hemangioma on the right half of the face (forehead, upper eyelid, and upper lip), and left hemiparesis. The magnetic resonance imaging of the skull indicated increased myelination in the right hemisphere (T2) and atrophy compatible with Sturge-Weber syndrome. Cerebral angiography indicated vasculopathy with bilateral moyamoya pattern, associated with other arteriovenous malformations compatible with cerebrofacial vascular metameric syndrome. Moyamoya syndrome was treated with indirect revascularization (pial synangiosis) achieving good outcomes.

DISCUSSION

Vascular malformations can involve the orbits, face, and brain simultaneously. CAMS with forebrain or hindbrain involvement can be classified into subgroups: I, II, and III. On the other hand, venous malformations in Sturge-Weber syndrome or encephalotrigeminal angiomatosis can be considered CVMS. Moyamoya disease is called syndrome when related to another clinical condition, such as the present case, i.e., neurocutaneous Sturge-Weber syndrome. The association of chronic moyamoya vasculopathy with cerebrofacial vascular metameric syndrome is rare. Further studies are required to establish the best treatment approach.

The lump of the medial canthus as diagnostic clue to cerebro-facial venous metameric syndrome: Report of a case

The Cerebro-Facial Venous Metameric Syndrome is characterized by ipsilateral venous/lymphatic anomalies involving simultaneously the brain and the face with a metameric distribution. This case report to describe a case of Cerebro-Facial Venous Metameric Syndrome presenting with a lump of the medial canthus. This was a case report a 24-year-old woman with a history of a mild headache, complained of a sporadic (at least once a month) serous leakage from the left eye and a small cutaneous protuberance in the left medial canthus, without focal neurological symptoms. The patient underwent brain Magnetic Resonance Imaging and findings were suggestive of a Cerebro-Facial Venous Metameric Syndrome 1-2. When multiple and ipsilateral vascular anomalies are observed, it should be considered the presence of Cerebro-Facial Metameric Syndrome, even without neurological symptoms and port-wine stains. Follow-up is mandatory, especially if there are cavernomas or facial arterio-venous malformations due to the risk of bleeding.

Venous pathologies in paediatric neuroradiology: from foetal to adolescent life

The interpretation of cerebral venous pathologies in paediatric practice is challenging as there are several normal anatomical variants, and the pathologies are diverse, involving the venous system through direct and indirect mechanisms. This paper aims to provide a comprehensive review of these entities, as their awareness can avoid potential diagnostic pitfalls. We also propose a practical classification system of paediatric cerebral venous pathologies, which will enable more accurate reporting of the neuroimaging findings, as relevant to the underlying pathogenesis of these conditions. The proposed classification system comprises of the following main groups: arterio-venous shunting-related disorders, primary venous malformations and veno-occlusive disorders. A multimodal imaging approach has been included in the relevant subsections, with a brief overview of the modality-specific pitfalls that can also limit interpretation of the neuroimaging. The article also summarises the current literature and international practices in terms of management options and outcomes in specific disease entities.

Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up

PURPOSE OF REVIEW

Identification of the underlying cause of pulsatile tinnitus is important for treatment decision making and for prognosis estimation. For this, an adequate diagnostic imaging strategy is crucial.

RECENT FINDINGS

Both CT and MRI can be useful, and in general, these modalities provide complementary diagnostic information. The scanning protocol can be optimized based on the estimated a priori chance for finding specific pathology, or the need to rule out more rare but clinical significant disease. In recent years, dynamic CTA, also referred to as 4D-CTA, has become available as a new technique that enables non-invasive evaluation of hemodynamics for the detection, classification, and follow-up of vascular malformations.

SUMMARY

The value of different diagnostic imaging modalities in the work-up of pulsatile tinnitus is discussed in relation to the differential diagnosis. Furthermore, imaging findings of different diseases are presented, both for CT and MRI.

Cerebrofacial Venous Metameric Syndrome 2 plus 3: Facial and Cerebral Manifestations

SUMMARY

A unique case of Cerebrofacial Venous Metameric Syndrome (CVMS) in a 25-year-old women is described with venous malformations involving simultaneously the brain and the face. This case represents CVMS 2 plus 3 according to the classification described by Lasjaunias et Al. The metameric distribution of the cerebrofacial venous syndromes is well illustrated in this case. The extracranial and intracranial involvement is described and the appearance on MRI imaging is detailed. In our opinion this case demonstrates that cerebrofacial venous metameric syndromes include a wide spectrum of possible phenotypes including Sturge Weber syndrome and cases such as we describe here.

Segmental Neurovascular Syndromes in Children

The concept of segmental vascular syndromes with different, seemingly unrelated, diseases is based on the embryology of the neural crest and the mesoderm migration of cells that share the same metameric origin. Migrating patterns of these cells link the brain, the cranial bones, and the face on the same side. A somatic mutation developing in the region of the neural crest or the adjacent cephalic mesoderm before migration can, therefore, be postulated to produce arterial or venous metameric syndromes, including PHACES, CAMS, Cobb syndrome, and Sturge-Weber syndrome. Although these diseases may be rare, their relationships among each other and their postulated linkage with the development of the neural crest and the cephalic mesoderm may shed light on the complex pathology and etiology of various cerebral vascular disorders.

Cerebellopontomandibular vascular malformation: a rare type of cerebrofacial arteriovenous metameric syndrome. Case report

The concept of a cerebrofacial arteriovenous metameric syndrome (CAMS) recently has been posited. A 22-year-old woman presented with gait ataxia. She had unilateral angiomatous lesions involving the lower face, the auricle, and the retromastoid area, as well as the tongue on the right side. Angiography revealed the presence of extensive arteriovenous malformations (AVMs) in the ipsilateral cerebellum and pons, in addition to those located in the facial region. The authors report a case of multiple AVMs of the face, cerebellum, and pons, corresponding to CAMS Type 3, and include a review of the literature.