Subarachnoid haemorrhage in paediatric hereditary haemorrhagic telangiectasia: a case report and literature review

PURPOSE: Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterised by telangiectasias and multi-organ arteriovenous malformations (AVMs). Subarachnoid haemorrhage (SAH) is rare in children with HHT, and intracranial aneurysms are scarcely reported. We describe the case of a 12-year-old boy with confirmed HHT who presented with a generalised tonic-clonic seizure, followed by headache and neck pain. MATERIALS AND METHODS: A narrative literature review was conducted to identify reported paediatric cases of SAH in patients with HHT. MEDLINE, Embase, the Cochrane Library, and CINAHL were searched. Five reports describing six paediatric patients were reviewed and summarised. RESULTS: Imaging revealed SAH with intraventricular extension. Initial imaging failed to detect any neurovascular malformation, but a small carotid cave aneurysm was identified as the likely haemorrhage source with subsequent digital subtraction angiography. Following treatment with endovascular flow-diverting stent placement, the patient remained neurologically stable. An unrecognised spinal AVM was discovered by whole-spine magnetic resonance imaging. CONCLUSIONS: This case highlights a rare mechanism of haemorrhage in paediatric HHT, the challenges of detecting small aneurysms with non-invasive imaging, and the importance of a multidisciplinary approach in guiding management. Improved awareness and robust literature on atypical cerebrovascular manifestations may inform future diagnostic and management strategies.