scholarly journals Cerebral arteriovenous malformations during pregnancy: a management dilemma

2019 ◽  
Vol 12 (11) ◽  
pp. e228759
Author(s):  
Rubina Sohail ◽  
Qasim Bashir ◽  
Shahlla Kanwal ◽  
Maryam Iqbal Ali
Keyword(s):  
Arteriovenous Malformations ◽  
Intracranial Haemorrhage ◽  
Multidisciplinary Approach ◽  
Rare Condition ◽  
Management Plan ◽  
Maternal Condition ◽  
Cerebral Arteriovenous Malformations ◽  
Risk Of Bleeding ◽  
Brain Avm ◽  
The Family

The rupture of a brain cranial arteriovenous malformation (bAVM) has been associated with pregnancy; however, due to scarcity of data about this rare condition, management still remains a dilemma both for obstetricians and neurophysicians. The management plan is decided after weighing the benefits of bAVM treatment against the risk of bleeding in pregnancy. There is consensus on deciding the treatment of ruptured brain AVM during pregnancy based on neurological and not obstetrical indications. The management is decided using a multidisciplinary approach.We report the case of a primigravida who presented at 15 weeks of gestation with intracranial haemorrhage secondary to ruptured bAVM, which was managed by glue embolisation. However, she presented again after 9 days in a moribund condition with fever, vomiting and malaise. The family was very concerned about the patient. The multidisciplinary team after evaluation of patient decided for hysterotomy based on the deteriorating maternal condition.

Associated arteriovenous malformation of the orbit and brain: a case of Wyburn-Mason syndrome without retinal involvement

2001 ◽  
Vol 95 (2) ◽  
pp. 346-349 ◽  
Author(s):  
Francisco A. Ponce ◽  
Patrick P. Han ◽  
Robert F. Spetzler ◽  
Alexa Canady ◽  
Iman Feiz-Erfan
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Rare Condition ◽  
Cerebral Arteriovenous Malformations ◽  
Cutaneous Lesions ◽  
Content Type ◽  
Gestational Period ◽  
Fourth Case ◽  
The Face ◽  
Fine Print

✓ Wyburn-Mason syndrome is a rare condition associated with multiple cerebral arteriovenous malformations. The disease, also called retinoencephalofacial angiomatosis, includes lesions of the retina, brain, and skin. This disorder stems from a vascular dysgenesis of the embryological anterior plexus early in the gestational period when the primitive vascular mesoderm is shared by the involved structures. The timing of the insult to the embryonic tissue determines which structures are affected. Extensions of the lesions vary widely but cutaneous lesions are unusual. Among reports in the literature, only three cases appear to have manifested without retinal involvement. The authors report the fourth case of Wyburn-Mason syndrome in which there was no retinal involvement and the first to involve neither the retina nor the face.

Multiple cerebral arteriovenous malformations associated with soft-tissue vascular malformations

1981 ◽  
Vol 54 (5) ◽  
pp. 670-672 ◽  
Author(s):  
Ahmed Hanieh ◽  
Peter C. Blumbergs ◽  
Paul G. Carney
Keyword(s):  
Soft Tissue ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Rare Condition ◽  
Cerebral Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Fine Print

✓ A patient found unconscious, probably due to a seizure, was discovered to have two intracranial arteriovenous malformations. Multiple arteriovenous malformations is a rare condition, and both lesions were excised successfully.

Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage

1998 ◽  
Vol 89 (4) ◽  
pp. 539-546 ◽  
Author(s):  
Gary Redekop ◽  
Karel TerBrugge ◽  
Walter Montanera ◽  
Robert Willinsky
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Presentation ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Risk Of Bleeding ◽  
Risk Rate ◽  
Risk Of Hemorrhage ◽  
Arterial Aneurysms ◽  
Fine Print

Object. The goal of this study was to develop a classification system for aneurysms associated with arteriovenous malformations (AVMs) based on their anatomical and pathophysiological relationships and to determine the incidence and bleeding rates for these aneurysms as well as the effects of AVM treatment on their natural history. Methods. Of 632 patients with AVMs, intranidal aneurysms were found in 35 (5.5%) and flow-related aneurysms in 71 (11.2%). Patients with intranidal aneurysms presented more frequently with hemorrhage (72% compared with 40%, p < 0.001) and had a 9.8% per year risk rate of bleeding during follow-up review. Twelve (17%) of the patients with flow-related aneurysms associated with an AVM presented with hemorrhage from an aneurysm, whereas 15 (21%) bled from their AVM. Seventeen patients underwent angiography after AVM treatment (mean 2.25 years). Of 23 proximal aneurysms, 18 (78.3%) were unchanged, four (17.4%) were smaller, and one (4.3%) had disappeared, whereas four (80%) of five distal aneurysms regressed completely and one was unchanged. Sixteen patients underwent angiography after partial AVM treatment (mean 3.8 years). In cases with less than a 50% reduction in the AVM, no aneurysms regressed, although two enlarged and bled. In cases with greater than a 50% reduction in the AVM, two of three distal aneurysms disappeared and five proximal aneurysms were unchanged. Conclusions. Arterial aneurysms associated with cerebral AVMs may be classified as intranidal, flow-related, or unrelated to the AVM nidus. Intranidal aneurysms have a high correlation with hemorrhagic clinical presentation and a risk of bleeding during the follow-up period that considerably exceeds that which would be expected in their absence. Patients with flow-related aneurysms in association with an AVM may present with hemorrhage from either lesion. Aneurysms that arise on distal feeding arteries near the nidus have a high probability of regressing with substantial or curative AVM therapy.

STUDY INTRACRANIAL HAEMORRHAGE IN CHILDREN AT HUE CENTRAL HOSPITAL

2014 ◽  
pp. 57-62
Author(s):  
Nu Van Anh Ton ◽  
Thi Thu Hien Nguyen
Keyword(s):  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Intracranial Haemorrhage ◽  
Older Children ◽  
Cerebral Arteriovenous Malformations ◽  
Cross Sectional ◽  
Study Results ◽  
Common Causes ◽  
The Difference ◽  
Brain Parenchymal

Objective: (i) Describe the clinical features, the subclinical intracranial hemorrhage in children. (ii) Identify the risk factors, causes of intracranial hemorrhage in children. Methods: Cross-sectional escriptive study. Results: Study on 34 children with intracranial hemorrhage, study reveals that more boys than girls. The rate of male / female: 2.4/1. The difference was statistically significant in infants under 1 year of age, p<0.05. 76.5% of children hospitalized in the first 24 hours of onset. In children under 1 year of age, symptom onset is the most common seizure 45.8%, poor feeding 25%. In children aged older one year-old, headaches are symptoms first appear 50%, changes in consciousness, seizures, weakness, usually no onset symptoms. Children over 7 days of hospitalization accounted for the highest 50%. The prothrombin rate from 20-50% accounted for the highest percentage of 45.5%. The fontanelle ultrasound in infants, highest percentage of cerebral hemorrhage - grade II 45.5%. With CTscan brain, parenchymal hemorrhage accounted for the highest percentage of 75%. Low- birth weight, asphyxia birth, congenital heart disease highest risk factor caused an intracranial hemorrhage. Common causes bleeding in the intracranial haemorrhage reduce the highest percentage of 64.7%, however, caused by cerebral arteriovenous malformations also relatively high proportion of 17.6%. 4. Conclusions: Children under 1 year- old onset seizures, poor feeding, and older children with a consciousness change. Common causes of incranial hemorrhage by reducing prothombin rate, cerebral arteriovenous malformations. Key words: Intracranial hemorrhage.

Subtotal obliteration of cerebral arteriovenous malformations after Gamma Knife surgery

2007 ◽  
Vol 106 (3) ◽  
pp. 361-369 ◽  
Author(s):  
Chun Po Yen ◽  
Peter Varady ◽  
Jason Sheehan ◽  
Melita Steiner ◽  
Ladislau Steiner
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Surgery ◽  
Cerebral Arteriovenous Malformations ◽  
Peripheral Dose ◽  
Risk Of Bleeding ◽  
The Mean ◽  
Risk Of Hemorrhage ◽  
Early Filling

Object Subtotal obliteration of cerebral arteriovenous malformations (AVMs) after Gamma Knife surgery (GKS) implies a complete angiographic disappearance of the AVM nidus but persistence of an early filling draining vein, indicating that residual shunting is still present; hence, per definition there is still a patent AVM and the risk of bleeding is not eliminated. The aim of this study was to determine the risk of hemorrhage for patients with subtotal obliteration of AVMs. Methods After GKS for cerebral AVMs, follow-up angiography demonstrated a subtotally obliterated lesion in 159 patients. Of these, in 16 patients a subtotally obliterated AVM developed after a second GKS was performed for the partially obliterated lesion. The mean age of these patients was 35.2 years at the time of the diagnosis of subtotally obliterated AVMs. The lesion volumes at the time of initial GKS treatment ranged from 0.1 to 11.5 cm3 (mean 2.5 cm3). The mean peripheral dose used in the 175 GKS treatments was 22.5 Gy (median 23 Gy, range 15–31 Gy). To achieve total obliteration of the AVM, 23 patients underwent a new GKS targeting the proximal end of the early filling vein. The mean peripheral dose given in these cases was 23 Gy (median 24, range 18–25 Gy). The incidence of subtotally obliterated AVMs was 7.6% from a total of 2093 AVMs treated and in which follow-up imaging was available. The diagnosis of subtotally obliterated AVMs was made a mean of 29.4 months (range 4–178 months) after GKS. The number of patient-years at risk (from the time of the diagnosis of subtotally obliterated AVMs until either the confirmation of a total obliteration of the lesion on angiography or the time of the latest follow-up angio-graphic study that still visualized the early filling vein) was a mean of 3.9 years, ranging from 0.5 to 13.5 years, and a total of 601 patient-years. There was no case of bleeding after the diagnosis of subtotally obliterated AVMs. Of 90 patients who did not undergo further treatment and in whom follow-up angiography studies were available, the same early filling veins still filled in 24 (26.7%), and the subtotally obliterated AVMs were subsequently obliterated in 66 patients (73.3%). In 19 patients who underwent repeated GKS for subtotally obliterated AVMs and in whom follow-up angiography studies were available, the AVMs were obliterated in 15 (78.9%) and remained patent in four (21.1%). Conclusions The fact that none of the patients with subtotally obliterated AVMs suffered a rupture is not compatible with the assumption of an unchanged risk of hemorrhage for these lesions, and implies that the protection from re-bleeding in patients with subtotal obliteration is significant. Subtotal obliteration does not necessarily seem to be a stage of an ongoing obliteration. At least in some cases it represents an end point of this process, with no subsequent obliteration occurring. This observation requires further confirmation by open-ended follow-up imaging.

Abstract 179: Brain Avm Embolization With Onyx: Clinical And Anatomical Results In A Prospective, Multicenter, European Study (BRAVO)

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Laurent Pierot ◽  
Keyword(s):  
Arteriovenous Malformations ◽  
Multidisciplinary Approach ◽  
Interventional Neuroradiology ◽  
High Rate ◽  
First Line ◽  
Complete Occlusion ◽  
Brain Arteriovenous Malformations ◽  
Brain Avm ◽  
Long Time ◽  
Brain Avms

Purpose: The treatment of brain arteriovenous malformations (AVMs) is challenging based on a multidisciplinary approach involving neurosurgery, radiosurgery, and interventional neuroradiology. The embolization of brain AVMS was for a long time performed using particles and glue. Onyx has been recently introduced in the armamentarium for AVM embolization, but large, multicenter evaluation is lacking. BRAVO study was conducted to evaluate the clinical and anatomical results of brain AVM embolization with Onyx. Materials and Methods: BRAVO (Brain ArterioVenous malformations embolization with Onyx) was a multicentric, prospective, consecutive study conducted in 11 neurointerventional centers in Europe. 117 patients harbouring brain AVMs embolized with Onyx were included. Clinical presentation was mostly hemorrhage (30.8%) and epilepsy (27.4%). AVM size was less than 3cm in 52.1% of cases and more than 3cm in 47.9% of cases. A mean number of 2.05 embolization sessions / patient were performed with injection of a mean of 2.4 ml Onyx / session. Results: Complete occlusion was obtained with Onyx embolization alone in a high percentage of cases (23.5% of all cases and 36.7% of AVM smaller than 3cm). Intra and post-operative bleeding related to the treatment was observed in 9.4% leading to death in 3.4% and neurologic worsening in 1.7%. Non-hemorrhagic permanent deficits were observed in 6.0% of cases. Treatment related morbidity (mRS>2) and mortality were respectively 5.1% and 4.3%. Conclusion: Embolization of brain AVMs with Onyx is associated with a high rate of complete occlusion with acceptable morbidity and mortality. Onyx has to be used as the first line embolization agent for the treatment of brain AVMs.

scholarly journals Clinical Quiz—A Rare Case of Anal Canal Duplication in the Context of Currarino Syndrome

2021 ◽  
Vol 09 (01) ◽  
pp. e68-e71
Author(s):  
Sean Jared Connor ◽  
Giulia Brisighelli ◽  
Nirav Patel ◽  
Marc A. Levitt
Keyword(s):  
Anal Canal ◽  
Rare Case ◽  
Multidisciplinary Approach ◽  
Rare Condition ◽  
Management Plan ◽  
Clinical Quiz ◽  
Presacral Mass ◽  
Currarino Syndrome ◽  
Sacral Defect ◽  
Anal Canal Duplication

AbstractCurrarino syndrome (CS) is a rare condition that presents with any combination of a sacral defect, a presacral mass, and an anorectal malformation. This collection, referred to as Currarino's triad, may not necessarily present as all three abnormalities in the diagnosis of the syndrome. Anal canal duplication (ACD) is an even rarer occurrence. We present a case that lies on the CS spectrum with an associated ACD and discuss a complex surgical challenge that necessitated a customized management plan, devised through a multidisciplinary approach.

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