Square Alopecia: A New Type of Transient Alopecia of the Scalp Following Fluoroscopically Endovascular Embolization
The case we present here is about a 38-year-old man who came to the emergency room in February 2013, due to nausea and diplopia of sudden onset, 1 day prior to admission. Physical examination revealed a limitation of ocular supraversion movements and bilateral absence of pupillary light reflex, consistent with dorsal midbrain syndrome. The blood analysis and blood cell count results were strictly normal. A CT scan showed a left dorsal midbrain hematoma with ventricular hemorrhage and incipient signs of hydrocephalus. Subsequently an intracranial arteriography confirmed the presence of a left posterior parasagittal AVM with contributions from posterior choroidal artery branches []. Endovascular treatment was performed with selective embolization with Glubran®20% without any complications. In May 2013, an angiographic control identified remains of the malformation, with bilateral posteromedial choroidal afferents. A new selective embolization was performed in July 2013, which achieved a complete devascularization of the AVM with excellent angiographic results.\nA month later, he presented to the Dermatology Department for hair loss localized in the occipital region of the head. Physical examination showed an alopecic square plaque of 5 cm × 5 cm with almost total hair loss, but without signs of inflammation []. Dermoscopy exam showed no exclamation mark hairs and bilateral superficial arterial pulses were normal.\nIn total, the patient was exposed to four angiographic procedures, two of them with endovascular therapy. The total radiation exposure time was approximately 150-200 min and the absorbed radiation dose after the last session was estimated at more than 4 Gy. Radiation-induced transient alopecia diagnosis was established and there was no need to start treatment. The hair grew back 2 months after the last procedure.