Family History of Headache and Epistaxis Associated with Ischemic Stroke/Iskemik Inme ile Iliskili Ailede Bas Agrisi ve Epistaksis Oykusu

A 34-year-old woman presented to the emergency room with symptoms of transient right arm weakness, hemoptysis, headache, and seeing stars. She revealed a long history of epistaxis. Despite receiving electro-coagulation therapy twice, her epistaxis redeveloped. We examined her chest and brain using computed tomography (CT) and magnetic resonance imaging (MRI). Her chest CT scan showed an arteriovenous malformation (AVM) in the right apex and the right lower lung, and the brain MRI indicated an AVM in her frontal head. After the surgical treatment of her pulmonary AVMs, her epistaxis was significantly improved. In addition, her pedigree suggested that her condition might be hereditary. Further investigations revealed that she had hereditary hemorrhagic telangiectasia (HHT) with mutations in the endoglin gene. Both the patient and her mother were affected. It is known that pulmonary arteriovenous fistulas (PAVFs) can cause intrapulmonary right-to-left shunts, which can lead to transient ischemic attacks. However, PAVFs may also cause critical neurologic disorders such as permanent hemiparesis, brain abscesses, and meningoencephalitis when not adequately treated. This case study demonstrates the need for surgical intervention to control pulmonary AVMs and their associated neurologic complications. Furthermore, patients with recurrent epistaxis or hemoptysis with a family history may benefit from genetic testing for HHT. Keywords: Pulmonary arteriovenous malformation, transient ischemic attack, hereditary hemorrhagic telangiectasia, transcranial Doppler, endoglin gene mutation Otuz dort yasindaki kadin hasta acil servise gecici sag kol gucsuzlugu, hemoptizi, bas agrisi ve "yildizlar gorme" semptomlari ile basvurdu. Hastanin uzun zamandir olan burun kanamalari oykusu vardi. Iki kez elektro-koagulasyon tedavisi gormesine ragmen burun kanamalarinin tekrarladigi ogrenildi. Bilgisayarli tomografi (BT) ve manyetik rezonans goruntuleme (MRG) ile hastanin toraksi ve beyni goruntulendi. Toraks BT'de sag akciger apekste ve sag alt lobta arteriyovenoz malformasyonlar (AVM) goruldu. Beyin MRG'de frontal bolgede bir AVM goruldu. Pulmoner AVM'lerin cerrahi tedavisinden sonra hastanin burun kanamasi onemli olcude azaldi. Ayrica hastanin soyagaci, durumunun kalitsal olabilecegini dusundurdu. Daha ileri arastirmalar, hastada endoglin geninde mutasyonlarla birlikte herediter hemorajik telenjiektazi (HHT) tanisini koydurdu. Hem hastanin kendisinin hem de annesinin etkilendigi gor