Multidisciplinary Approach to Suspected Sudden Death Caused by Arteriovenous Malformation Rupture: A Case Report

Arteriovenous malformations (AVMs) are rare congenital conditions with a prevalence of less than 1% and are mostly asymptomatic. However, these malformations can suddenly cause intense pain or bleeding, leading to life-threatening medical problems. This report presents a case of an unexpected death in a 37-year-old previously healthy woman due to an intra-cerebellum arteriovenous malformation rupture identified during autopsy. While infective processes where preliminarily excluded, a Post Mortem Computed Tomography (PMCT) identified a tetra ventricular hemorrhage and intra-cerebellum hemorrhage. Toxicological examination was negative for most substances of abuse. During autopsy an intense hemorrhagic infiltrate in the subarachnoid space was observed. After formalin fixation of the brain the cerebellum showed hemorrhagic infarction on fourth ventricle sides, as well as several small reddish infarctions across the entire cerebellum parenchyma. Histological examination of the brain and cerebellum showed a suffusion of erythrocytes in the sub-arachnoid region. Evidence of an arterio-venous malformation, with several intertwine vessels of variable diameter, surrounded by hemorrhagic evidence. The autopsy played a crucial role in identifying the location and the possibly affected vessel, as well as defining the cause of death. It is necessary to have a greater number of autopsies to make an epidemiological contribution. Furthermore, it is crucial to create a multicenter data network with other authors from other departments to improve information about epidemiological, clinical, diagnostic and therapeutic data. Most brain AVMs as cause of death are often undiscovered.

Download Full-text

Association of venous and true arteriovenous malformation: a rare entity among mixed vascular malformations of the brain

Journal of Neurosurgery ◽

10.3171/jns.1995.83.1.0141 ◽

1995 ◽

Vol 83 (1) ◽

pp. 141-144 ◽

Cited By ~ 32

Author(s):

Bernhard Meyer ◽

Armin P. Stangl ◽

Johannes Schramm

Keyword(s):

Arteriovenous Malformation ◽

Vascular Malformations ◽

Venous Malformation ◽

Rare Entity ◽

Venous Malformations ◽

Content Type ◽

Hemorrhagic Infarction ◽

The Brain ◽

Cerebrovascular Malformation ◽

Fine Print

✓ In this article the authors report the case of a mixed cerebrovascular malformation in which a true arteriovenous malformation (AVM), harboring a nidus, is associated with a venous malformation that serves as the draining vein for the nidus. Despite the authors' preoperative rationale for exclusive extirpation of the AVM, an inadvertent injury and the obliteration of the venous malformation generated delayed postoperative neurological deterioration, which could clearly be attributed to venous hemorrhagic infarction. Because this is only the second instance of this type of mixed vascular malformation of the brain reported, which also underscores the concept of nonsurgical treatment of venous malformations, the authors discuss the diverse literature regarding mixed vascular malformations and the treatment of venous malformations.

Download Full-text

Death, a Rare Complication of Cranioplasty in Emergency: A Case Report

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/43799.15355 ◽

2021 ◽

Author(s):

Nandakishore Sahoo ◽

Sudarshan Bhat ◽

Mohan Rangan

Keyword(s):

Rare Complication ◽

Skin Flap ◽

Epidural Haematoma ◽

Emergency Procedure ◽

Unexpected Death ◽

Cosmetic Procedure ◽

High Infection ◽

Life Threatening ◽

The Brain ◽

Parasagittal Meningioma

Cranioplasty is a reconstructive procedure which is performed to restore the calvarial integrity with either a stored autologous bone flap or a custom synthetic prosthesis. It is performed to protect the brain and as a cosmetic procedure. It has been shown to improve patient’s functional outcome. This procedure has been performed as early as <14 days postdecompressive craniectomy. Cranioplasty in emergency which is a variant of secondary cranioplasty is rarely indicated after decompressive craniectomy. Complication rate associated with cranioplasty is relatively high. Infection, convulsions, and epidural haematoma are frequent complications of cranioplasty which are not life threatening. Fatal complications associated with this procedure are not well documented and that could be among one of the reason that death, as a complication following cranioplasty is substantially low. Here, a case of unexpected death of a 37-year-old female postcranioplasty which was performed as an emergency procedure is reported. She was a previous case of right mid one-third parasagittal meningioma who developed severe sinking skin flap syndrome after three months of parasagittal craniectomy. The patient was operated under general anaesthesia for reconstruction of the residual calvarial defect. However, the patient developed bacterial meningitis and on the 16th day postcranioplasty procedure, she died of cardiac arrest. The procedure had otherwise been uneventful and it was speculated that infection and cerebral oedema postcranioplasty might have been the cause of death.

Download Full-text

Galvos smegenų arterioveninės malformacijos

Lietuvos chirurgija ◽

10.15388/lietchirur.2009.3.2133 ◽

2009 ◽

Vol 7 (3-4) ◽

pp. 0-0

Author(s):

Irena Bičkutė ◽

Mindaugas Avižonis

Keyword(s):

Arteriovenous Malformation ◽

Vascular Disease ◽

Key Words ◽

Arteriovenous Malformations ◽

Regional Hospital ◽

Capillary Network ◽

Physiological Changes ◽

Brain Avm ◽

Life Threatening ◽

The Brain

Irena Bičkutė1, Mindaugas Avižonis21 Švenčionių rajono ligoninė, Partizanų g. 4, LT-18126 Švenčionys2 Mykolo Marcinkevičiaus ligoninė, Kauno g. 7/2, LT-03215 VilniusEl paštas: [email protected] Galvos smegenų arterioveninė malformacija (AVM) – įgimta smegenų patologija, kuriai būdingos patologinės arterijų ir venų jungtys, kuriomis arterinis kraujas patenka į smegenų venas, aplenkdamas normalų kapiliarų tinklą. Ši patologija reta, tačiau sukelia daug anatominių ir fiziologinių pokyčių, kelia pavojų gyvybei. Straipsnyje trumpai aprašoma AVM paplitimas, kilmė, patologija, klinika, diagnostika ir gydymas. Reikšminiai žodžiai: galvos smegenų arterioveninė malformacija, etiologija, epidemiologija, klinika, diagnostika, gydymas. Arteriovenous malformations of the brain Irena Bičkutė1, Mindaugas Avižonis21 The Švenčioniai Regional Hospital, Partizanų g. 4, LT-18126 Švenčionys, Lithuania2 The Mykolas Marcinkevičius Hospital, Kauno str. 7/2, LT-03215 Vilnius, LithuaniaE-mail: [email protected] Arteriovenous malformation (AVM) of the brain is a congenital vascular disease and has three morphologic components: the dysplastic vascular nidus, the feeding arteries, and the draining veins. The underlying lesion appears to represent a perpetuation of primitive arteriovenous communications which normally should be replaced by an intervening capillary network. AVM is potentially life-threatening and causes many anatomical and physiological changes. This article contains a description of epidemiology, etiology, pathology, clinic, diagnostics and treatment of brain AVM. Key words: arteriovenous malformation of the brain, etiology, epidemiology, clinic, diagnostics, treatment

Download Full-text

Histopathology of brain AVMs part II: inflammation in arteriovenous malformation of the brain

Acta Neurochirurgica ◽

10.1007/s00701-020-04328-3 ◽

2020 ◽

Vol 162 (7) ◽

pp. 1741-1747

Author(s):

Roosa Wright ◽

Patrik Järvelin ◽

Henri Pekonen ◽

Sara Keränen ◽

Tuomas Rauramaa ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Brain Avms ◽

The Brain

Download Full-text

Fact file 1: Critical care and emergency medicine

10.1093/oso/9780198792079.003.0014 ◽

2017 ◽

Author(s):

Daisy Fancourt

Keyword(s):

Emergency Medicine ◽

Critical Care ◽

Sports Medicine ◽

Orthopaedic Surgery ◽

Extreme Environment ◽

Disaster Medicine ◽

Medical Attention ◽

Life Threatening ◽

Medical Disciplines ◽

The Brain

Emergency medicine involves the care of patients who require immediate medical attention. The specialty encompasses a broad range of medical disciplines, including anaesthesia, cardiology (a field related to the heart), neurology (a field related to the brain), plastic surgery, orthopaedic surgery (surgery relating to the bones or muscles), and cardiothoracic surgery (surgery relating to the heart, chest, or lungs). There are also a number of subspecialties including extreme environment medicine, disaster medicine and sports medicine. Related to emergency medicine is the specialty of critical care medicine, which is concerned with the care of patients with life-threatening conditions often treated in intensive care settings....

Download Full-text

Aquaporin-1 and aquaporin-9 gene variations in sudden infant death syndrome

International Journal of Legal Medicine ◽

10.1007/s00414-020-02493-9 ◽

2021 ◽

Author(s):

Siri Hauge Opdal ◽

Linda Ferrante ◽

Torleiv Ole Rognum ◽

Arne Stray-Pedersen

Keyword(s):

Sudden Infant Death Syndrome ◽

Infant Death ◽

Brain Function ◽

Sudden Infant Death ◽

Sudden Infant ◽

Unexpected Death ◽

Aquaporin 9 ◽

Genes Encoding ◽

External Risk ◽

The Brain

AbstractSeveral studies have indicated that a vulnerability in the development and regulation of brain function is involved in sudden infant death syndrome (SIDS). The aim of this study was to investigate the genes encoding the brain aquaporins (AQPs) AQP1 and AQP9 in SIDS. The hypothesis was that specific variants of these genes are part of the genetic vulnerability predisposing infants to sudden unexpected death. The study included 168 SIDS cases with a median age of 15.5 (range 2–52) weeks and 372 adolescent/adult deceased controls with a median age of 44 (range 11–91) years. In the AQP1 gene, the rs17159702 CC/CT genotypes were found to be associated with SIDS (p = 0.02). In the AQP9 gene, the combination of a TT genotype of rs8042354, rs2292711 and rs13329178 was more frequent in SIDS cases than in controls (p = 0.03). In the SIDS group, an association was found between genetic variations in the AQP1 gene and maternal smoking and between the 3xTT combination in the AQP9 gene and being found lifeless in a prone position. In conclusion, this study adds further evidence to the involvement of brain aquaporins in SIDS, suggesting that specific variants of AQP genes constitute a genetic predisposition, making the infant vulnerable to sudden death together with external risk factors and probably other genetic factors.

Download Full-text

Unilateral mydriasis in a child with a ventriculoperitoneal shunt for obstructive hydrocephalus: a diagnostic dilemma

BMJ Case Reports ◽

10.1136/bcr-2020-237257 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237257

Author(s):

Monidipa Banerjee ◽

Eiman Haj Ahmed ◽

Kathryn Foster ◽

Arundoss Gangadharan

Keyword(s):

Ipratropium Bromide ◽

Obstructive Hydrocephalus ◽

Sudden Onset ◽

Unique Case ◽

Diagnostic Dilemma ◽

Vp Shunt ◽

Life Threatening ◽

Unilateral Mydriasis ◽

The Brain ◽

Rule Out

There are several causes for sudden onset unilateral mydriasis, however impending transtentorial uncal herniation needs to be ruled out. This unique case highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. A 3-year-old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute respiratory distress. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. An urgent CT scan of the brain did not show any new intracranial abnormality. A case of pharmacological anisocoria was diagnosed that resolved completely within 24 hours of discontinuation of ipratropium bromide. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus. This emphasises the urgency in evaluating unilateral mydriasis to rule out life-threatening conditions. Clinicians should remember that ipratropium administered through ill-fitting face masks could cause this completely reversible adverse effect.

Download Full-text

Bedside examination of the vestibular and ocular motor system in patients with acute vertigo or dizziness

Clinical and Translational Neuroscience ◽

10.1177/2514183x19886158 ◽

2019 ◽

Vol 3 (2) ◽

pp. 2514183X1988615

Author(s):

Alexander A Tarnutzer ◽

Marianne Dieterich

Keyword(s):

Diagnostic Testing ◽

Initial Assessment ◽

Head Impulse Test ◽

Motor Deficits ◽

Ocular Motor ◽

Bedside Examination ◽

Life Threatening ◽

Ocular Motor System ◽

Bedside Tests ◽

The Brain

In the initial assessment of the patient with acute vertigo or dizziness, both structured history-taking and a targeted bedside neuro-otological examination are essential for distinguishing potentially life-threatening central vestibular causes from those of benign, self-limited peripheral labyrinthine origin and thus for deciding on further diagnostic testing. In this article, the key elements of the vestibular and ocular motor examination, which should be obtained at the bedside in these acutely dizzy patients, will be discussed. Specifically, this will include the following five domains: ocular stability for (I) nystagmus and for (II) eye position (skew deviation), (III) the head-impulse test (HIT), (IV) postural stability, and (V) ocular motor deficits of saccades, smooth pursuit eye movements, and optokinetic nystagmus. We will also discuss the diagnostic accuracy of specific combinations of these bedside tests (i.e. HIT, testing for nystagmus and vertical divergence, referred to as the H.I.N.T.S. three-step examination), emphasizing that the targeted neuro-otological bedside examination is more sensitive for identifying central causes in acute prolonged vertigo and dizziness than early MRI of the brain.

Download Full-text