To the Editor.—Recently, Boynton and Morgan1 described an infant with a positive family history of hereditary hemorrhagic telangiectasia (HHT) who died of congestive heart failure secondary to a large cerebral arteriovenous (AV) malformation. The authors believed their case was a unique instance of large cerebral AV malformation associated with HHT. However, other such cases have been reported previously2-4 and we have seen an additional example in a 46-year-old man with typical HHT, whose angiogram revealed a large AV malformation in the left frontal-parietal area and a smaller one in the right frontal pole. Cerebral vascular malformations of smaller and unspecified size have also been described in patients with HHT.5-10 In its relation to HHT, Boynton and Morgan's case was unusual only with respect to the early age at which the cerebral AV malformation manifested.
In view of the high frequency of neurological symptoms in HHT, such