Adenosine-Induced Cardiac Arrest for Transvenous Embolization of Midbrain Arteriovenous Malformation

2019 ◽  
Vol 18 (6) ◽  
pp. E184-E190 ◽  
Author(s):  
Jaims Lim ◽  
Hussain Shallwani ◽  
Kunal Vakharia ◽  
Adnan H Siddiqui
Keyword(s):  
Arteriovenous Malformation ◽  
Transarterial Embolization ◽  
Posterior Wall ◽  
Sudden Onset ◽  
High Flow ◽  
Neurological Deficits ◽  
Transvenous Embolization ◽  
Blurred Vision ◽  
Systemic Hypotension ◽  
The Right

Abstract BACKGROUND AND IMPORTANCE Few studies describe the use of adenosine-induced cardiac systole for treatment of cerebrovascular pathologies. We describe a midbrain arteriovenous malformation (AVM) treated with transvenous embolization using adenosine-induced asystole to achieve transient systemic hypotension with the purpose of furthering discussion on the technique and operative considerations for adenosine use in endovascular AVM treatments. CLINICAL PRESENTATION A 29-yr-old man presented with sudden onset of severe bilateral headache, blurred vision, and numbness on the right side of his face and tongue. Noncontrast head computed tomography revealed fourth ventricle hemorrhage. Diagnostic cerebral angiography revealed a high-flow midbrain AVM with a posterior wall perforator from the basilar artery terminus and a draining vein into the straight sinus. Transarterial AVM embolization was successful. The patient was discharged with no residual neurological deficits but returned 1 wk later with slurred speech and left-sided dysmetria. Repeat angiography revealed partial AVM filling. Attempts at transarterial embolization were unsuccessful. Thus, transvenous AVM embolization with adenosine-induced cardiac asystole and systemic hypotension was performed. A total of 60 mg of adenosine was administered, followed by 2 additional doses of 60 and 40 mg; and complete cardiac asystole with a mean arterial pressure of 40 mmHg was maintained, resulting in successful embolization of the AVM. No residual filling was visualized on postembolization arterial angiography runs. The patient was neurologically stable and discharged on postoperative day 2. CONCLUSION With appropriate and safe dosing, adenosine-induced asystole and systemic hypotension may be a feasible, safe option to reduce flow and assist endovascular transvenous embolization of high-flow AVMs.

scholarly journals Ischemic stroke with agraphestesia signal focus

2021 ◽  
Author(s):  
Ana Luísa Lopes Espínola da Costa Reis ◽  
Leonardo Henrique Gandolfi de Souza ◽  
Vitor Roberto Pugliesi Marques
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Parietal Lobe ◽  
Cerebral Arteries ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Ischemic Event ◽  
The Right ◽  
Sensory Ability

Introduction: The ischemic stroke is one of the main causes of death and disability in Brazil. Among the main risk factors are age, atrial fibrillation (AF), diabetes, dyslipidemia and physical inactivity. The main etiology of stroke is cardioembolic, resulting in obstruction of the cerebral arteries by a thrombus of cardiac origin. The artery most affected in ischemic strokes is the middle cerebral artery. The stroke has main characteristics, with emphasis on the sudden onset of symptoms, involvement of a focal area, ischemia caused by obstruction of a vessel and neurological deficits depending on the affected area. Graphesthesia is defined as a cutaneous sensory ability to recognize letters or numbers traced on the skin. The loss of this sensory ability is known as agraphesthesia. Case Report: M.A.F.O. female, 78a, arrived at the UPA complaining of mental confusion. Patient denies previous stroke. Personal history of systemic arterial hypertension. Upon physical examination, the patient was conscious, self and disoriented and inattentive. He was able to repeat and evoke words, without measurable motor déficits. Left upper limb with agraphestesia. Computed tomography was requested, which showed an extensive hypodense area in the right parietoccipital region, which leads to the erasure of the furrows between the adjacent gyres, which may correspond to a recent ischemic event. Magnetic resonance imaging, diffusion-restricted area with correspondence on the ADC map, located in the right temporoparietal region inferring an acute ischemic event. An electrocardiogram was also requested, which showed an irregular rhythm, characteristic of atrial fibrillation, resulting in a diagnostic hypothesis of cardioembolic ischemic stroke. Discussion: The involvement of post-central ischemic gyrus lesions may correspond to paresthesia, anesthesia, hypoesthesia; the involvement of secondary and terciary areas of sensitivity in the upper parietal lobe, especially in the active movements of the hand and in the modalities of integrated sensitivity, their lesions may be clinically affected by: apraxias, dysgraphias, hemineglect, agraphestesia, stereoagnosia and spacial disorientation.

scholarly journals Giant hyperostosis after sphenoid ridge en plaque meningioma removal

2014 ◽  
Vol 21 (4) ◽  
pp. 471-476
Author(s):  
Danil Adam ◽  
Toma Papacocea ◽  
Ioana Hornea ◽  
Cristiana Moisescu
Keyword(s):  
Brain Mri ◽  
Growth Patterns ◽  
Neurological Deficits ◽  
X Rays ◽  
Blurred Vision ◽  
Orbital Cavity ◽  
Orbital Wall ◽  
The Central Nervous System ◽  
The Right ◽  
Sphenoid Ridge

Abstract Meningioma is in most cases a benign tumor of the central nervous system with two growth patterns: en masse and en plaque. Hyperostosis is associated in 13 - 49 % of the cases with en plaque meningioma. We describe the case of a 47 years old woman with meningotelial sphenoid ridge meningioma which was totally removed. At the first admission she presented with no neurological deficits, seizures and a mild right exophthalmos. This had an indolent growth. After 10 years, the patient was readmitted for headache, blurred vision and right exophthalmos. Skull X-rays and brain MRI revealed an important thickening of the right superior orbit wall and sphenoid ridge. She underwent a new surgery. There was no intradural tumor found. Instead, bones of the superior and lateral right orbit walls were very hiperostotic. A hole of 3/2 cm in the right superior orbital wall was drilled and the orbital cavity was decompressed. In the postoperative period, the symptoms were remitted and the exophthalmos reduced. We discuss the causes and management of hyperostosis associated with meningiomas.

scholarly journals Contralateral De Novo Intraosseous Arteriovenous Malformation in a Child with Arteriovenous Malformation of Mandible Treated by Endovascular Embolotherapy

2012 ◽  
Vol 18 (4) ◽  
pp. 484-489 ◽  
Author(s):  
C-H Yeh ◽  
Y-M Wu ◽  
Y-L Chen ◽  
H-F Wong
Keyword(s):  
Arteriovenous Malformation ◽  
De Novo ◽  
Transarterial Embolization ◽  
Subsequent Development ◽  
Cyanoacrylate Glue ◽  
Direct Puncture ◽  
Life Threatening ◽  
Detachable Coils ◽  
The Right

We describe our experience of the development of contralateral de novo intraosseous AVMs in a ten-year-old girl with AVMs of the mandible who underwent endovascular embolotherapy. She initially presented with intermittent oral bleeding. Computed tomography and digital subtraction angiography demonstrated intraosseous AVMs within the right mandible. The AVMs were treated by transosseous direct-puncture and transarterial embolization with Guglielmi detachable coils and n-butyl cyanoacrylate glue. However, de novo intraosseous AVMs developed within the previously healthy contralateral mandible and resulted in dangerous oral bleeding. Therefore, we suggest regular follow-up and prompt retreatment of any residual mandibular AVMs in patients undergoing endovascular or surgical treatment to prevent subsequent development of “secondary” AVMs and life-threatening oral bleeding.

Tentorial Dural Arteriovenous Fistula Presenting with Various Visual Symptoms Related to Anterior and Posterior Visual Pathway Dysfunction: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 222-227 ◽  
Author(s):  
Goetz Benndorf ◽  
Stefanie Schmidt ◽  
Wolf-Peter Sollmann ◽  
Stefan-Nikolaus Kroppenstedt
Keyword(s):  
Cavernous Sinus ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Visual Pathway ◽  
Sudden Onset ◽  
Left Vertebral Artery ◽  
Visual Symptoms ◽  
Meningeal Arteries ◽  
History Of ◽  
The Right

Abstract OBJECTIVE AND IMPORTANCE Dural arteriovenous fistulae (DAVFs) not directly shunting into the cavernous sinus are an infrequent cause of visual dysfunction. An unusual case of a tentorial DAVF associated with visual symptoms related to dysfunction of the anterior and posterior visual pathway is presented. CLINICAL PRESENTATION A 38-year-old woman with a history of long-standing bilateral proptosis experienced a sudden onset of headache and visual disturbances. Ocular examination revealed bilateral episcleral and retinal venous congestion, optic disc paleness, right superior homonymous quadrantanopsia in both eyes, and concentric narrowing of the visual field of the right eye. Angiography revealed a DAVF supplied by a falx branch arising from the left vertebral artery and both middle meningeal arteries, which drained directly into the markedly dilated vein of Galen via the basal vein of Rosenthal and the cavernous sinus into both superior ophthalmic veins. INTERVENTION Endovascular treatment was performed in two consecutive sessions by transarterial embolization with n-butylcyanoacrylate, which resulted in occlusion of the fistula and complete clinical cure, confirmed at the 6-month follow-up examination. CONCLUSION Various neuro-ophthalmological findings may be caused by an arteriovenous lesion remote from the optic organ as a result of rerouting of venous drainage compromising the visual pathway at different locations. Transarterial embolization of a DAVF may result in complete cure if advantageous arterial anatomy allows for flow control and occlusion of the fistulous connection with liquid adhesives.

scholarly journals Transvenous embolization of thalamic arteriovenous malformation under transient cardiac standstill

2019 ◽  
Vol 46 (Suppl_1) ◽  
pp. V10
Author(s):  
Leonardo Rangel-Castilla ◽  
Hussain Shallwani ◽  
Adnan H. Siddiqui
Keyword(s):  
Magnetic Resonance Imaging ◽  
Arteriovenous Malformation ◽  
Transarterial Embolization ◽  
Endovascular Embolization ◽  
Transvenous Embolization ◽  
Ventricular Pacing ◽  
Resonance Imaging ◽  
Rapid Ventricular Pacing ◽  
One Year ◽  
Cerebrovascular Surgery

Transvenous embolization (TE) has been increasingly applied for arteriovenous malformation (AVM) treatment. Transient cardiac standstill (TCS) has been described in cerebrovascular surgery but is uncommon for endovascular embolization. The authors present a patient with a ruptured thalamic AVM in whom both techniques were applied simultaneously. Surgery was considered, but the patient refused. Transarterial embolization was performed with an incomplete result. The deep-seated draining vein provided sole access to the AVM. A microcatheter was advanced into the draining vein. Under TCS, achieved with rapid ventricular pacing, complete AVM embolization was obtained. One-year magnetic resonance imaging and cerebral angiography demonstrated no residual AVM.The video can be found here: https://youtu.be/CAzb9md_xBU.

Evolution of the Management of Tentorial Dural Arteriovenous Malformations

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 750-762 ◽  
Author(s):  
Patrick R. Tomak ◽  
Harry J. Cloft ◽  
Akihiko Kaga ◽  
C. Michael Cawley ◽  
Jacques Dion ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Therapeutic Strategy ◽  
Transarterial Embolization ◽  
Treatment Strategies ◽  
Venous Drainage ◽  
Neurological Deficits ◽  
Transvenous Embolization ◽  
Single Institution ◽  
Clinical Presentations

Abstract OBJECTIVE Tentorial dural arteriovenous malformations (DAVMs) are uncommon lesions associated with an aggressive natural history. Controversy exists regarding their optimal treatment. We present a single-institution series of tentorial DAVMs treated during a 12-year period, address the current controversies, and present the rationale for our current therapeutic strategy. METHODS Twenty-two patients with tentorial DAVMs were treated between 1988 and 2000. Treatment consisted of transarterial or transvenous embolization, surgical resection, disconnection of venous drainage, or a combination of these therapies. The clinical presentations, radiological features, treatment strategies, and results were studied. RESULTS Eighteen patients (82%) presented with intracranial hemorrhage or progressive neurological deficits. Retrograde leptomeningeal venous drainage was documented in 22 cases (100%), classifying the lesions as Borden Type III. Angiographic follow-up monitoring was performed for 0 to 120 months and clinical follow-up monitoring for 1 to 120 months. Posttreatment angiography demonstrated obliteration in 22 cases (100%). Two patients experienced neurological decline after endovascular treatment and died. All of the 20 surviving patients exhibited clinical improvement; there were no episodes of rehemorrhage or new neurological deficits. Outcomes were excellent in 17 cases (77%), good in 2 cases (9%), and fair in 1 case (5%), and there were 2 deaths (9%). CONCLUSION Tentorial DAVMs are aggressive lesions that require prompt total angiographic obliteration. Disconnection of the venous drainage from the fistula may be accomplished with transarterial embolization to the venous side, transvenous embolization, or surgical disconnection of the fistula. We think that extensive nidal resections carry more risk and are unnecessary. We do not think there is a role for stereotactic radiosurgery in the treatment of these lesions.

scholarly journals Bilateral Petrous Ridge Dural Arteriovenous Malformations Treated by a Combination of Endovascular Embolization and Surgical Excision

2006 ◽  
Vol 12 (3) ◽  
pp. 269-275 ◽  
Author(s):  
S.O. Seong ◽  
C. David ◽  
In Sup Choi
Keyword(s):  
Arteriovenous Malformations ◽  
Transarterial Embolization ◽  
Surgical Excision ◽  
Endovascular Embolization ◽  
Transvenous Embolization ◽  
First Case ◽  
The Right

We report the first case of bilateral complex petrosal arteriovenous malformations (AVM). The patient was treated by a combination of transarterial embolization and surgical excision on the right-sided AVM, and by transarterial and transvenous embolization on left-sided lesion.

Arteriovenous malformation of the conus supplied by the artery of Desproges-Gotteron

2011 ◽  
Vol 14 (4) ◽  
pp. 529-531 ◽  
Author(s):  
R. Shane Tubbs ◽  
Martin M. Mortazavi ◽  
Andrew J. Denardo ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Arteriovenous Malformation ◽  
Transarterial Embolization ◽  
Conus Medullaris ◽  
Treatment Interventions ◽  
First Case ◽  
Plantar Aspect ◽  
Repeat Angiography ◽  
The Right ◽  
Spinal Avm

The artery of Desproges-Gotteron is rarely mentioned in the literature and is unfamiliar to most neurosurgeons. The authors report a unique case of an arteriovenous malformation (AVM) of the conus in an adult woman, which received blood supply from an artery of Desproges-Gotteron. The patient presented with intermittent pain radiating down the right posterior thigh and foot and transient bladder incontinence. On examination, there was weakness of the right lower limb with hypalgesia of the plantar aspect of the right foot. Magnetic resonance imaging revealed a mass near the anterior aspect of the conus medullaris and angiography confirmed a spinal AVM at the L-1 level and a shunt located at the inferior L-3 level. The patient underwent transarterial embolization, and at 2-year follow-up, repeat angiography demonstrated no evidence of residual or recurrent spinal AVM, intermittent and tolerable pain without treatment interventions, and a normal neurological examination. The artery of Desproges-Gotteron appears to be a rare arterial variation. Moreover, the authors believe this to be the first case of a conal AVM supplied by such an artery. The anatomy and implications of such an arterial variant are discussed.

Sign in / Sign up

Export Citation Format

Share Document