The clinical and pathological spectrum of brain-stem vascular malformations. Long-term course stimulates multiple sclerosis.

Three cases of brain-stem vascular malformation with progressive and fluctuating clinical courses of longer than one year were studied. One patient with a rare brain-stem arteriovenous malformation lived for 20 years with symptoms notably similar to those of multiple sclerosis (MS). One case each of cavernous hemangioma and capillary telangiectasis are also described. The clinical, roentgenographic, and pathologic features of these three cases plus 18 other cases of brain-stem vascular malformations from the literature, with progressive or intermittent clinical courses and with survival of longer than one year from the onset of symptoms, are reviewed. Since nearly all of these cases were once mistakenly diagnosed as MS, a diagnostic approach is proposed to help distinguish brain-stem vascular malformations from MS prior to an obvious subarachnoid hemorrhage.