{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:02:16Z","timestamp":1756339336094,"version":"3.44.0"},"reference-count":26,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T00:00:00Z","timestamp":1712016000000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,3,1]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Hereditary haemorrhagic telangiectasia (HHT) has an estimated prevalence of 1 in 5000\u20138000 individuals globally with pulmonary arteriovenous malformations (PAVMs) affecting approximately 15%\u201350% of HHT patients. Ischaemic stroke is a known complication of PAVMs that affects \u226430% of patients with PAVMs. Studies have shown that patients with PAVMs have ischaemic stroke a decade earlier than routine stroke. The predominant mechanism of ischaemic stroke in HHT patients is paradoxical embolism due to PAVMs, but most HHT-related PAVMs are asymptomatic. Additionally, HHT is often underdiagnosed in patients and poses a challenge to physicians due to its rarity. We present a case of a patient with ischaemic stroke who was subsequently diagnosed with HHT and found to have a PAVM on further evaluation. This case highlights the importance of using an individualised patient-centred stroke evaluation and screening for PAVMs in patients who had a stroke with possible or suspected HHT and definite HHT.<\/jats:p>","DOI":"10.1136\/bcr-2023-257682","type":"journal-article","created":{"date-parts":[[2024,4,4]],"date-time":"2024-04-04T13:40:24Z","timestamp":1712238024000},"page":"e257682","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Personalised stroke evaluation and management: tailoring individualised patient care for hereditary haemorrhagic telangiectasia"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4743-6624","authenticated-orcid":false,"given":"Zackary","family":"Park","sequence":"first","affiliation":[{"name":"Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Randy","family":"Dunston","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"},{"name":"Neurology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamra","family":"Ranasinghe","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"},{"name":"Neurology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,4,4]]},"reference":[{"key":"2025082622524790000_17.4.e257682.1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.010984"},{"key":"2025082622524790000_17.4.e257682.2","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2020-238385","article-title":"Hereditary Haemorrhagic telangiectasia and pulmonary Arteriovenous malformations","volume":"14","author":"Dunphy","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2025082622524790000_17.4.e257682.3","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201407-1254CI"},{"key":"2025082622524790000_17.4.e257682.4","doi-asserted-by":"crossref","DOI":"10.1186\/1750-1172-7-33","article-title":"A long diagnostic delay in patients with hereditary Haemorrhagic telangiectasia: A questionnaire-based retrospective study - Orphanet Journal of rare diseases","volume":"7","author":"Pierucci","year":"2012","journal-title":"Orphanet J Rare Dis"},{"key":"2025082622524790000_17.4.e257682.5","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1017\/cjn.2022.80","article-title":"Neurologic complications in hereditary hemorrhagic telangiectasia with pulmonary Arteriovenous malformations: A systematic review","volume":"50","author":"Agarwal","year":"2023","journal-title":"Can J Neurol Sci"},{"key":"2025082622524790000_17.4.e257682.6","doi-asserted-by":"crossref","first-page":"325","DOI":"10.21037\/cdt.2018.06.01","article-title":"Pulmonary Arteriovenous malformations: diagnosis","volume":"8","author":"Saboo","year":"2018","journal-title":"Cardiovasc Diagn Ther"},{"key":"2025082622524790000_17.4.e257682.7","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1443"},{"key":"2025082622524790000_17.4.e257682.8","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182a08d59"},{"key":"2025082622524790000_17.4.e257682.9","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-8628(20000306)91:1<66::AID-AJMG12>3.0.CO;2-P"},{"key":"2025082622524790000_17.4.e257682.10","doi-asserted-by":"crossref","first-page":"302","DOI":"10.3171\/2016.7.JNS16847","article-title":"Prevalence and characteristics of brain Arteriovenous malformations in hereditary hemorrhagic telangiectasia: A systematic review and meta-analysis","volume":"127","author":"Brinjikji","year":"2017","journal-title":"J Neurosurg"},{"key":"2025082622524790000_17.4.e257682.11","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A6549"},{"key":"2025082622524790000_17.4.e257682.12","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.74.6.743"},{"key":"2025082622524790000_17.4.e257682.13","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-247877","article-title":"Intracardiac versus Extracardiac shunt in a young man with ischaemic stroke","volume":"15","author":"Carrington","year":"2022","journal-title":"BMJ Case Rep"},{"key":"2025082622524790000_17.4.e257682.14","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-245529","article-title":"Pulmonary Arteriovenous malformation as a cause of ischaemic stroke in the elderly","volume":"14","author":"Lu\u00eds","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2025082622524790000_17.4.e257682.15","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2377-11-84","article-title":"Stroke in hereditary hemorrhagic telangiectasia patients. 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