Brain capillary telangiectasias (BCT) are small, solitary, clinically-indolent lesions that are most often found incidentally on advanced neuroimaging studies or during pathological examination at autopsy. They are composed of multiple, dilated, thin-walled capillaries with intermixed normal brain parenchyma and are commonly located in the striate pons. Radiographically, these lesions are best visualized on magnetic resonance imaging (MRI) studies that include T1-weighted imaging with gadolinium contrast, T2*/gradient echo sequences, and susceptibility weighted images. Given their low flow hemodynamic state, cerebral angiography studies are typically unremarkable (i.e., angiographically-occult).
While the vast majority of BCTs are asymptomatic, both symptomatic ruptured and symptomatic unruptured cases of BCTs have been reported in the literature. In the setting of an intracerebral hemorrhage adjacent to a BCT, it is more likely that the causative lesion is an accompanying, more aggressive vascular malformation (e.g., BCT “mixed” with either an arteriovenous malformation [AVM] or cavernous malformation [CM]).
The size, location, MR signal characteristics, and stability on longitudinal imaging studies are all features that are highly suggestive for a BCT. In the absence of overt neurological signs and symptoms referable to a BCT, we would recommend a conservative approach when dealing with these mostly benign vascular malformations.
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