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Vol. 1. Issue 6.
Pages 367-374 (January 1990)
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Vol. 1. Issue 6.
Pages 367-374 (January 1990)
Malformaciones vasculares cerebrales angiograficamente ocultas. Informe sobre cinco casos
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A. Bárcena Orbe, C. Mestre Moreiro, J.M. Cañizal García, J. Rodríguez Hernández
Servicio de Neurocirugía. Hospital del Aire. Madrid
F. Esteban Alonso*
* Sección de Neurorradiología. Hospital del Aire. Madrid
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Resumen

Las malformaciones vasculares cerebrales ocultas o crípticas, (MVC), constituyen una entidad patológica, cuya certeza diagnóstica mejora progresivamente gracias al uso combinado de la Tomografía Axial Computada, (TAC), y la Resonancia Magnética Nuclear, (RMN), de alto campo magnético.

La apariencia de ciertas áreas lesionales con encendido postcontraste, que pasan desapercibidas con frecuencia en la TAC simple, asociadas a imágenes de RMN, sugerentes de hemorragias de diferente edad, rodeadas de halos hipointensos, sobre todo en secuencias T2, en relación a su vez con depósitos de hemosiderina, constituyen las características de estas lesiones. Sin embargo las imágenes otenidas son tan sólo fenómenos indirectos de la presencia de las MVC; por lo que es posible encontrar hallazgos TAC que dan lugar a falsos negativos, sobre todo en la fase de reabsorción del hematoma. De igual modo, en los exámenes RMN pueden aparecer diagnósticos falsamente positivos, (tumor hemorrágico, granuloma, etc…).

Se describen en este trabajo cinco casos de MVC. Tres de ellas intervenidas quirúrgicamente, con la correspondiente corroboración histológica. Otra fue tratada mediante la unidad gamma, y finalmente es descrito el seguimiento del último paciente, no tratado, durante tres años de evolución.

Discutimos los cambios sufridos por la hemoglobina extravasada, tras los tratamientos aplicados, así como su evolución espontánea en el caso no sometido a terapia, en relación a los hallazgos obtenidos por las imágenes RMN de control.

Finalmente se cuestiona el valor de la RMN, como procedimiento diagnóstico de seguimiento y de valor pronóstico, tras la aplicación del tratamiento quirúrgico o radioterápico.

Palabras clave:
Malformación cerebrovascular oculta
angioma
resonancia magnética nuclear
hematoma
epilepsia
Summary

Occult cerebral vascular malformation, (OCVM) is a condition in which the diagnostic specifity day to day improves by using both the Computed Tomography, (CT), and High-Field Magnetic Resonance, (MR), images in combination. The appearance of CT enhanced postcontrast areas, perhaps irrelevant on plain CT films, associated to multiple hemorrhages of varying ages sourrounded by a hypointense zone, most prominent on T2 weighted MR sequences and representing hemosiderin deposits, are characteristic but indirect findings of OCVM. However, CT Scans show false-negative suspicious images in the solving hematoma phase, while MR procedures are capable of false positive diagnosis (bleeding tumor, granuloma, etc…).

Five cases of OCVMs are described here, three of them were operated upon and histological assesment being obtained; another one was managed with highenergy stereotactic radiotherapy; and a 3-years followup period of the fifth, a non-treated patient, is also showed. Secondary biochemical-induced changes on the extravasated hemoglobin and its magnetic behaviour correlations are discussed in sorne detail. Finally, the rol of postherapy MR is questioned on the basis of its nonspecific hematological subproducts-related images.

Key words:
Occult cerebral vascular malformation
angioma
magnetic resonance images
hematoma
epilepsy

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