ABSTRACT
Multiple brain arteriovenous malformations (bAVM) are rare neurovascular lesions usually related to genetic syndromes. Its management is not well established given its rarity. The objective of this study was to describe the clinical and angiographic features of published cases and to explore their associations with treatment outcomes. We performed a literature search of published cases in Medline and the Regional Index Medici. Additional cases were searched in our single-center registry. Data on the proportions of patients and clinical and angiographic characteristics were extracted. The study outcomes were nidal instability in patients who underwent staged treatment and radiological cure in patients who underwent treatment using any treatment modality. Logistic regression models for the study outcomes were analyzed. Data on the proportions of multiple bAVM patients were summarized with meta-analyses of proportions. We included 118 patients (reported in 68 studies) from the literature and 6 cases identified in our registry. A total of 124 patients harboring 339 bAVM nidi were included in the analyses. Differences between syndromic and non-syndromic cases were observed. The logistic regression analyses showed that angiographically occult untreated bAVM was associated (OR 14.37; 95% CI 2.17 to 95.4) with nidal instability after staged treatment, and deep (OR 5.11; 95% CI 1.51 to 17.27) and eloquent (OR 3.91; 95% CI 1.22 to 12.52) locations were associated with residual disease after treatment. Inconsistent reporting of relevant data throughout the included studies undermined the planned analyses. Some prognostic factors were found to be related to the study outcomes. Study Registration: The protocol of the systematic review was registered in PROSPERO as CRD42021245814.
Subject(s)
Intracranial Arteriovenous Malformations , Humans , Intracranial Arteriovenous Malformations/surgery , Brain/pathology , Treatment Outcome , AngiographyABSTRACT
OBJECTIVE: This case study aims to present the Foreign Accent Syndrome (FAS) in a patient with Cerebral Arteriovenous Malformation (cAVM), considering neuropsychological, radiological and microsurgical aspects. METHODS: The patient underwent preoperative neuropsychological assessment and MRI and Tractography were performed to identify fibers close to the lesion site. In the surgical procedure, a craniotomy was performed for excision of the cAVM. After surgery and 6 months after the surgical procedure, the patient underwent further and neuropsychological evaluations. RESULTS: The presence of AVM located in the posterior part of the medial surface of the left superior frontal gyrus was identified and the neuropsychological evaluation found cognitive deficits and symptoms characteristic of FAS, which disappeared after resection. CONCLUSION: This report presented a case of cAVM in which symptoms were found even without rupture, which was no longer observed after the surgical procedure, demonstrating the relationship of cAVM with the symptoms and neuroanatomical bases of FAS.
ABSTRACT
La patogénesis de los aneurismas intracraneales asociados a malformaciones arteriovenosas cerebrales no es bien entendida y es aún objeto de discusión. Las decisiones sobre cuándo y cómo tratar los aneurismas intracraneales de estas características siempre han sido un reto terapéutico tanto para neurocirujanos vasculares como para terapistas endovasculares neurológicos. Reportamos el caso de una paciente de 51 años con aneurismas múltiples asociados a una malformación arteriovenosa, así como su manejo neuroquirúrgico, con un análisis comparativo con lo publicado en la literatura médica y científica en los últimos 10 años.The pathogenesis of intracranial aneurysms associated with arteriovenous malformations is not well understood and is still under discussion; the decisions about when and how to treat intracranial aneurysms of these characteristics have always been a therapeutic challenge for both, vascular neurosurgeons and endovascular neurological therapists. We report the case of a 51-year-old patient with multiple aneurysms associated with arteriovenous malformation, as well as her neurosurgical management, with a comparative analysis what has been published in the medical and scientific literature in the last 10 years.
Subject(s)
Intracranial Arteriovenous Malformations , Aneurysm , Arteriovenous Fistula , Female , Humans , Intracranial Arteriovenous Malformations/surgery , Middle AgedABSTRACT
La coartación de aorta en neonatos se puede manifestar como insuficiencia cardíaca según el grado de obstrucción. Hay situaciones que pueden simular una coartación de aorta en los recién nacidos. Limitarse a la imagen típica de muesca aórtica en la ecocardiografía para diagnosticar una coartación de aorta puede inducir a error y demorar el diagnóstico adecuado. Se presenta el caso de un recién nacido con insuficiencia cardíaca con diagnóstico inicial de coartación de aorta y, posteriormente, de malformación arteriovenosa cerebral. Se debe considerar la malformación arteriovenosa en el diagnóstico diferencial de un recién nacido con insuficiencia cardíaca.
Coarctation of the aorta in neonates can manifest as heart failure when there is a certain degree of obstruction. There are some situations that can simulate a coarctation of the aorta in newborns. Diagnosis of coarctation of the aorta based solely on the typical aortic arch image on echocardiography can be misleading and delay an accurate diagnosis. We describe an unusual case of a newborn with heart failure who was initially diagnosed with coarctation of the aorta and then with cerebral arteriovenous malformation. We must consider the cerebral arteriovenous malformation in the differential diagnosis of a newborn with heart failure.
Subject(s)
Humans , Male , Infant, Newborn , Intracranial Arteriovenous Malformations/diagnostic imaging , Heart Failure , Embolization, Therapeutic , Hypertension, PulmonaryABSTRACT
Coarctation of the aorta in neonates can manifest as heart failure when there is a certain degree of obstruction. There are some situations that can simulate a coarctation of the aorta in newborns. Diagnosis of coarctation of the aorta based solely on the typical aortic arch image on echocardiography can be misleading and delay an accurate diagnosis. We describe an unusual case of a newborn with heart failure who was initially diagnosed with coarctation of the aorta and then with cerebral arteriovenous malformation. We must consider the cerebral arteriovenous malformation in the differential diagnosis of a newborn with heart failure.
La coartación de aorta en neonatos se puede manifestar como insuficiencia cardíaca según el grado de obstrucción. Hay situaciones que pueden simular una coartación de aorta en los recién nacidos. Limitarse a la imagen típica de muesca aórtica en la ecocardiografía para diagnosticar una coartación de aorta puede inducir a error y demorar el diagnóstico adecuado. Se presenta el caso de un recién nacido con insuficiencia cardíaca con diagnóstico inicial de coartación de aorta y, posteriormente, de malformación arteriovenosa cerebral. Se debe considerar la malformación arteriovenosa en el diagnóstico diferencial de un recién nacido con insuficiencia cardíaca.
Subject(s)
Aortic Coarctation/diagnosis , Intracranial Arteriovenous Malformations/diagnosis , Diagnosis, Differential , Heart Failure/complications , Humans , Infant, Newborn , Intracranial Arteriovenous Malformations/complications , MaleABSTRACT
Se presenta el caso clínico de una paciente de 26 años, portadora de malformación arteriovenosa cerebral (MAV) gigante frontal izquierda diagnosticada hace 12 años por epilepsia sintomática secundaria, coordinada para cesárea de segunda gestación de 39 semanas, realizándose anestesia combinada raquídea peridural sin incidentes y con buenos resultados materno fetales.
Subject(s)
Humans , Female , Pregnancy , Young Adult , Cesarean Section/methods , Intracranial Arterial Diseases/complications , Anesthesia, Spinal/methods , Anesthesia, Epidural/methods , Anesthesia, Obstetrical/methodsABSTRACT
RESUMEN Se presenta el caso clínico de una paciente de 26 años, portadora de malformación arteriovenosa cerebral (MAV) gigante frontal izquierda diagnosticada hace 12 años por epilepsia sintomática secundaria, coordinada para cesárea de segunda gestación de 39 semanas, realizándose anestesia combinada raquídea peridural sin incidentes y con buenos resultados materno fetales.
SUMMARY We report the clinical case of a 26 years old, with cerebral arteriovenous malformation (AVM) giant left frontal diagnosed 12 years ago by symptomatic epilepsy secondary, cesarean coordinated second gestation of 39 weeks, performing combined spinal epidural anesthesia without incident and maternal fetal successfully.
RESUMO Apresenta-se o caso clinico de uma paciente de 26 anos, portadora de uma malformação arteriovenosa cerebral gigante frontal esquerda, diagnosticada por epilepsia sintomática á 12 anos prévio a esta situação e coordenada para cesariana com 39 semanas de gestação. Foi realizada anestesia combinada raqui-peridural sem incidente e com bons resultados materno-fetais.
ABSTRACT
Se presenta una paciente que fue investigada y operada en el Hospital Universitario Gral Calixto García, portadora de una malformación arteriovenosa cerebral, que desapareció espontáneamente después de un cuadro neurológico de intensa gravedad. Arteriográficamente se comprobó que estaba asociada a un aneurisma arterial en su mismo sistema vascular cerebral. La paciente había sufrido 3 eventos neurológicos en orden ascendente de gravedad, y fue el último motivo de ingreso en la Unidad de Terapia Intensiva, con un nivel de 5 en la escala de Glasgow para el coma y sin signos meníngeos evidenciables. La lesión valorada como malformación arteriovenosa cerebral en las tomografías axiales cumputarizadas previas, no se evidenció en la panangiografía cerebral realizada en la fase de mejoría clínica relativa después de su etapa más crítica. Dicha angiografía demostró un aneurisma arterial homolateral a la malformación arteriovenosa ya desaparecida, el cual fue excluido de la circulación por presillamiento de su cuello sin eventos transoperatorios ni posoperatorios relevantes. Se realiza una revisión de la literatura al respecto(AU)
Authors present the case of a patient researched and operated on in the General Calixto García University Hospital presenting with a cerebral arteriovenous malformation disappeared spontaneously after a neurologic picture of intense severity. From the arteriographic point of view it was verified that it was associated with an arterial aneurysm present in her same cerebral vascular system. The patient has had three neurological events in rising order of severity which was the last reason for admission in the Intensive Therapy Unit (ITU) with a level of 5 in the Glasgow scale for the coma and without obvious meningeal signs. The injury classified as a cerebral arteriovenous malformation according to the previous computerized axial tomographies was not evidenced in the cerebral panangiograpy carried out in the clinical phase improvement after its more critical stage. Such angiography demonstrated the presence of a arterial aneurysm homolateral to the already disappeared arteriovenous malformation, which was excluded of the circulation by means of stitching of neck without transoperative and postoperative significant events. In this respect, author made a literature review(AU)