Occlusive vascular disease associated with cerebral arteriovenous malformations

Selective carotid angiography and computed tomography were used in a study of the association of occlusive vascular disease with cerebral arteriovenous malformations in 13 patients. The arterial occlusions ranged from focal stenosis in the major artery supplying the malformation to complete occlusion of the supraclinoid internal carotid artery with subsequent development of "moyamoya" collaterals. The majority of the arterial occlusions were proximal to the vascular malformation. Some, however, extended distal to the major branch supplying the arteriovenous malformation (AVM). Selective angiography with subtraction techniques defines the distinct angioarchitecture of these AVMs and the associated stenoses and collateral telangiectases.     

Brain arteriovenous malformations

An arteriovenous malformation (AVM) is a particular abnormality of blood vessels. Brain AVMs are congenital, but symptoms usually do not appear until the second decade of life - if at all. The most common presenting symptom is a brain hemorrhage, but other possible symptoms include neurological deficits, seizures and headaches. Until recently, the gold standard for diagnosing AVM was conventional angiography. However, computed tomography and magnetic resonance angiography are now the first-line diagnostic tools for AVMs. This article reviews the presenting symptoms, diagnostic procedures and treatment options for brain AVMs, including embolization, micro-surgery and radiosurgery. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your CE preference. For access to other quizzes, go to www.asrt.org/store.     

Inflammatory demyelinating disease mimicking malignant glioma.

The differential diagnosis between inflammatory demyelinating disease and malignant glioma is difficult based only on neuroimaging methods. METHODS: Four patients with inflammatory demyelinating disease who presented with clinical and neuroimaging findings strongly suggestive of malignant glioma were examined. RESULTS: MRI showed a mass lesion with prolonged T1 and T2 values and gadolinium enhancement in all cases. Proton MR spectroscopy and (201)Tl SPECT showed findings supportive of the diagnosis of malignant glioma in all cases. However, surgical biopsy revealed inflammatory demyelinating disease. After the diagnosis, 2 patients were treated by steroid administration and 2 were just observed. The gadolinium enhancement of all lesions decreased and finally disappeared. CONCLUSION: Such cases illustrate the importance of considering a demyelinating lesion in the differential diagnosis of a mass lesion. The difficulties encountered in establishing the correct diagnosis of inflammatory disease are related to the variations in the radiologic appearance, which require exclusion of gliomas or other brain tumors by surgical biopsy before the therapeutic strategy can be selected.     

Occipital dural arteriovenous malformations

Summary The angiographic features of four occipital dural arteriovenous malformations are presented. Special attention is directed to their blood supply from cervical branches of the subclavian artery and to their venous drainage.

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Occipitale durale arteriovenöse Mißbildungen

Zusammenfassung Beschreibung von 4 Patienten mit occipital gelegenen duralen arteriovenösen Mißbildungen. Die Blutversorgung geschah hauptsächlich über cervicale Äste der A. subclavia.

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Malformations artério-veineuses durales occipitales

Résumé Dans cette communication on discute l'aspect angiographique de quatre malformations artérioveineuses durales occipitales en portant une attention spéciale sur le drainage veineux et sur l'afference par branches cervicales de l'artère sous-clavière.

     

Posterior fossa arteriovenous malformations

Summary Classically, posterior fossa arteriovenous malformations (PF-AVMs) have been considered as lesions with high tendency to bleed. However, careful analysis of clinical and autopsy data from the literature demonstrate that in fact the incidence of hemorrhage is similar in infratentorial and supratentorial locations. The clinical perception that most of the diagnosed PF-AVMs had bled does not mean that they have a high risk of hemorrhage. It suggests that bleeding is the dominant way of expression, since other symptoms are uncommon. Furthermore, angioarchitectural analysis is similar in supra-an infratentorial locations. The causes of hemorrhage are probably related to venous anatomic and hemodynamic changes or associated aneurysms as in other intracranial AVMs.     

Pulmonary varix mimicking arteriovenous malformation

We report here a case of a 44-year-old female with a pulmonary varix. The patient was asymptomatic; a routine chest X-ray incidentally revealed a serpiginous mass in the left hilar region. Computed tomography revealed a serpiginous, dilated vascular structure in the left upper lobe that continued into the lower lobe and was suggestive of an arteriovenous malformation. Pulmonary angiography revealed no arterial abnormality; however, the filling of an abnormally dilated pulmonary vein was observed. Angiography is considered to be the most useful method for the confirmatory diagnosis of pulmonary varices.     

Cerebellar arteriovenous malformations in children

We review the presentation, imaging findings and outcome in 18 children with cerebellar arteriovenous malformations (AVM). This group is of particular interest because of the reported poor outcome despite modern imaging and neurosurgical techniques. All children had CT and 15 underwent catheter angiography at presentation. Several of the children in the latter part of the study had MRI. Of the 18 children, 17 presented with a ruptured AVM producing intracranial haemorrhage. The remaining child presented with temporal lobe epilepsy and was shown to have temporal, vermian and cerebellar hemisphere AVM. This child had other stigmata of Osler-Weber-Rendu syndrome. Three other children had pre-existing abnormalities of possible relevance. One had a vascular malformation of the cheek and mandible, one a documented chromosomal abnormality and another a midline cleft upper lip and palate. Six of the 17 children with a ruptured cerebellar AVM died within 7 days of the ictus. Vascular pathology other than an AVM was found in 10 of the 14 children with a ruptured cerebellar AVM who had angiography: 4 intranidal aneurysms, 5 venous aneurysms and 2 cases of venous outflow obstruction (one child having both an aneurysm and obstruction). The severity of clinical presentation was directly related to the size of the acute haematoma, which was a reasonable predictor of outcome. Received: 14 October 1996 Accepted: 10 October 1997     

Stereotactic radiosurgery of arteriovenous malformations

Stereotaxis has been introduced at the Joint Center for Radiation Therapy in Boston, MA, to aid in the precise localization and treatment of arteriovenous malformations (AVMs). A Brown-Roberts-Wells stereotactic system and a 6 MV linear accelerator have been modified for these treatments. By using multiple isocentric rotational fields, radiation doses from 1500 to 2500 cGy can be safely prescribed to the AVM in efforts to occlude the blood vessels without risking damage to nearby radiosensitive structures. Sixteen patients have been treated from February 1986 to July 1988 using the technique described.     

Anomalous unilateral single pulmonary vein: two cases mimicking arteriovenous malformations and a review of the literature

Total anomalous pulmonary venous drainage is a rare congenital anomaly. It usually involves a pulmonary to systemic venous shunt and most cases have a septal defect in order to survive. Anomalous pulmonary venous drainage with pulmonary venous shunting is an extremely rare and entirely benign entity. We present two such cases, in which there was atresia of the left superior pulmonary vein and drainage via a tortuous collateral vein to the left inferior pulmonary vein. This collateral was mistaken on plain film and CT for a pulmonary arteriovenous malformation. Awareness of this anomalous unilateral single pulmonary vein and its radiological appearances may help in avoiding unnecessary pulmonary angiography.     

无水乙醇栓塞治疗耳部动静脉畸形

目的 介绍22例耳部动静脉畸形无水乙醇介入栓塞治疗的经验.方法 对22例耳部动静脉畸形患者,通过局部穿刺或经导管内超选择径路达到耳部病变的异常血管团内,根据病变的血管团构筑,采用无水乙醇或稀释乙醇进行栓塞,间隔1个月进行电话随访,间隔3～4个月进行临床随访,根据临床检查或血管造影评价临床效果.结果 22例患者共进行了38次无水乙醇栓塞,每次无水乙醇的用量为4～65 ml.9例病变局限患者,1～2次栓塞后达到临床治愈;13例病变广泛患者,无水乙醇栓塞3～5次后,溃疡愈合,出血停止,耳呜消失或减弱.血管造影见9例异常血管团完全消失;8例血管团消失50%～75%;5例血管闭消失小于50%.最常见的并发症为可逆性局部坏死和水疱形成.结论 无水乙醇栓塞是耳部动静脉畸形安全、有效的治疗方式,并有可能成为首选的治疗方式.     

Transcatheter embolization of uterine arteriovenous malformations

A case of congenital arteriovenous malformation of the uterus in a 25-year-old woman with a long-standing history of recurrent menometrorrhagia is reported. Radiological diagnosis was based on hysterographic, computed tomographic, and angiographic findings. Treatment was performed with percutaneous transcatheter embolization.