Extensive cerebral arteriovenous malformation presenting as a small cutaneous lesion on the forehead

Abstract

Conflict of interest: none declared. A 10‐year‐old girl was referred to us for consideration of pulsed‐dye laser therapy to a lesion on the forehead. The lesion had been present at, or soon after birth and had increased in size in proportion to the child’s growth. The child and her family were keen to explore possible treatments for what was viewed as a cosmetic problem. On direct questioning, a long history of right frontal headaches was reported. Six months before presentation to us, the patient had been admitted to a neighbouring hospital with an episode of severe headache. No neurological deficit was associated with this episode and the symptoms resolved spontaneously. The patient had been discharged, and no imaging had been performed at that time. On examination (Fig. 1), a small palpable and pulsatile erythematous lesion was found with macular erythema above and to the right of the lesion. There was a further subtle area of macular erythema to the glabella.