Successful treatment of bilateral multiple pulmonary arteriovenous malformations in a patient with brain abscess and severe hypoxemia using a combination of transcatheter embolotherapy and surgical resection: a case report.

BACKGROUND: A pulmonary arteriovenous malformation is an abnormal dilated blood vessel that makes direct communication between a pulmonary artery and pulmonary vein and can be associated with hypoxemia or neurological complications, including brain abscess and cerebral infarction. Treatment of pulmonary arteriovenous malformation includes surgical resection and transcatheter embolotherapy, however the adaptation of therapies should be considered when a patient is in bad condition. CASE PRESENTATION: A 51-year-old man was admitted after developing fever, consciousness disorder, and hypoxemia. Magnetic resonance imaging of the brain showed a brain abscess. Bilateral pulmonary arteriovenous malformations were found by contrast computed tomography. Because of a family history of pulmonary arteriovenous malformation, a history of epistaxis, and the existence of oral mucosa telangiectasia, he was diagnosed with hereditary hemorrhagic telangiectasia and brain abscess caused by intrapulmonary right-to-left shunt. The brain abscess improved with antibiotic treatment; however, the administration of oxygen did not ameliorate his hypoxemia. His hypoxemia was exacerbated by positive pressure ventilation. Considering his systemic and respiratory condition, we considered surgery to involve a high degree of risk. After controlling his brain abscess and pneumonia, transcatheter embolotherapy was performed. This improved his systemic condition, enabling surgical treatment. CONCLUSIONS: This middle-aged patient suffering from brain abscess and severe hypoxemia with multiple pulmonary arteriovenous malformations was successfully treated by a combination of transcatheter embolotherapy and surgery. The adaptation and combination of therapies, as well as the sequence of treatments, should be considered depending on the patient status and lesions.

Pure misallocation of "0" in number transcoding: a new symptom of right cerebral dysfunction.

To account for the mechanism of number transcoding, many authors have proposed various models, for example, semantic-abstract model, lexical-semantic model, triple-code model, and so on. However, almost all of them are based on the symptoms of patients with left cerebral damage. Previously, I reported two Japanese patients with right posterior cerebral infarction showing pure misallocation of "0" (omission: "40,265"-->"4,265," addition: "107"-->"1,007," transposition: "4,072"-->"4,702") both in writing and oral reading of Arabic numerals. To examine whether the pure misallocation of "0" is commonly observed in patients with right cerebral damage, I investigated writing and oral reading of Arabic numerals in 18 patients with right cerebral damage and 16 healthy controls. All patients with right cerebral damage showed pure misallocation of "0" both in writing and reading. The pure misallocation of "0" due to right cerebral damage cannot be explained by current models. It may be more useful to explain the phenomenon by regarding an Arabic numeral as graph on a two-dimensional plane composed of two axes (place-holding values and digits).