scholarly journals Case Report: Gyral Brain Arteriovenous Malformation with Presentation Isolated From Intraventricular Hemorrhage

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Rizky Fawzyana Sarengat ◽  
Achmad Firdaus Sani
Keyword(s):  
Arteriovenous Malformation ◽  
Intraventricular Hemorrhage ◽  
Clinical Manifestations ◽  
Chief Complaint ◽  
Communicating Hydrocephalus ◽  
Brain Arteriovenous Malformation ◽  
Centrum Semiovale ◽  
History Of ◽  
Ruptured Avm ◽  
Grade 3

Introduction: Brain Arteriovenous Malformation (BAVM) is a rare disease with an incidence rate of 1.3 out of 100,000 people. The most common clinical manifestations in BAVM patients are intracranial hemorrhage. There were 38.5% of BAVM patients who had intraventricular hemorrhage (IVH), and the rate of IVH without parenchymal bleeding in the ruptured AVM is 7.8%. We reported a case of BAVM with intraventricular hemorrhage presentation without intracerebral hemorrhage (isolated IVH). Case: Male, 15 years old, with a chief complaint of acute decreased consciousness on activity, followed by vomiting and general onset seizures. There was no history of hypertension or trauma before. From the neurological examination, the GCS is 225, and there were positive pathological reflexes on both sides. From a head CT scan without contrast, we found IVH in bilateral lateral ventricles, ventricle III and ventricle IV, communicating hydrocephalus, and brain edema. Head and Neck Computed Tomography Angiography (CTA) found a compact AVM in the left centrum semiovale-cortex parietal (Spetzler Martin AVM grading system grade 3). Patients underwent EVD surgery for hydrocephalus. The following steps are cerebral DSA as the gold standard for AVM diagnostic and targeted embolization to prevent further bleeding. Conclusion: One of the causes of Isolated Intraventricular Hemorrhage (IIVH) is AVM. In this case, although the topography of AVM is in the gyral, it can cause IIVH manifestation if there is contact between the AVM nidus and the ventricle.

scholarly journals Isolated Intraventricular Hemorrhage Associated with Cerebral Vasospasm and Delayed Cerebral Ischemia following Arteriovenous Malformation Rupture

2018 ◽  
Vol 7 (6) ◽  
pp. 479-489 ◽  
Author(s):  
Krishna Amuluru ◽  
Fawaz Al-Mufti ◽  
Charles E. Romero ◽  
Chirag D. Gandhi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Arteriovenous Malformation ◽  
Cerebral Angiography ◽  
Intraventricular Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Statistical Significance ◽  
Delayed Cerebral Ischemia ◽  
Ruptured Avm ◽  
Level Of Significance

Background: Although it is well characterized in aneurysmal subarachnoid hemorrhage, vasospasm is exceedingly rare following cerebral arteriovenous malformation (AVM) rupture. Subsequently, this complication is poorly characterized with regard to delayed cerebral ischemia (DCI). We review cases of ruptured AVM to assess the frequency and severity of vasospasm on cerebral angiography, and DCI. Summary: We reviewed our institutional database of acute intracranial hemorrhages between 2005 and 2014. We identified patients with cerebral AVM rupture and evidence of vasospasm, which was confirmed with digital subtraction angiography (DSA). Cerebral angiograms were evaluated by 2 blinded neurointerventionalists for vasospasm. Statistical analyses were conducted on the angiographic results and variables of interest to determine predictors and associations of vasospasm and DCI. Thirty-six patients with acute intracranial hemorrhage due to ruptured cerebral AVM subsequently underwent cerebral angiography. The interrater reliability for vasospasm was 0.81. The incidence of vasospasm was 13.9% and the incidence of subsequent DCI was 11.1%. A significant relationship existed between isolated intraventricular hemorrhage and vasospasm (p = 0.001) and subsequent DCI (p = 0.006). Radiographic vasospasm was associated with DCI in 80% of the patients (p < 0.0001). No statistical significance existed between subarachnoid hemorrhage and the development of vasospasm or DCI (p = 1.000 and p = 0.626, respectively). All differences were significant at a 99% level of significance. Key Message: In cases of ruptured AVM, isolated intraventricular hemorrhage appears to be an independent risk factor for vasospasm and DCI. Vasospasm must be considered during late neurological deterioration following AVM hemorrhage, especially in the setting of isolated intraventricular hemorrhage.

scholarly journals Seizures after Onyx Embolization for the Treatment of Cerebral Arteriovenous Malformation

2011 ◽  
Vol 17 (3) ◽  
pp. 331-338 ◽  
Author(s):  
K. De Los Reyes ◽  
A. Patel ◽  
A. Doshi ◽  
N. Egorova ◽  
F. Panov ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Retrospective Review ◽  
Arteriovenous Malformations ◽  
Clinical History ◽  
Median Number ◽  
Cerebral Arteriovenous Malformation ◽  
Brain Arteriovenous Malformation ◽  
Cerebral Arteriovenous Malformations ◽  
History Of ◽  
New Onset

Onyx embolization of cerebral arteriovenous malformations (AVM) has become increasingly common. We explored the risk of seizures after Onyx use. A retrospective review was conducted of 20 patients with supratentorial brain arteriovenous malformation (AVM) who received Onyx embolization between 2006 and 2009. Baseline demographics, clinical history, seizure history, AVM characteristics and treatment were compared between those who developed post-onyx seizure and those who did not. MRIs were reviewed for edema following Onyx treatment. Of 20 patients who underwent Onyx embolization, the initial AVM presentation was hemorrhage in 40% (N=8). The median number of embolizations was two (range 1–4) and the median final obliteration amount was 90% (range 50–100%). A history of seizure was present in 50% (N=10) of patients pre-embolization and 12 (60%) patients received seizure medications (treatment or prophylaxis) prior to embolization. Seizur post-Onyx embolization occurred in 45% (N=9). The median time to seizur post-Onyx was seven days (range 0.3–210). Four patients (20%) with seizures post-Onyx had no seizure history. Two of these patients (10%) had no other identifiable cause for seizure other than recent Onyx embolization. Seizures in these two patients occurred within 24 hours of Onyx administration. Among patients with post-Onyx seizures, there was a trend toward larger AVM size (P=0.091) and lower percent obliteration (P=0.062). Peri-AVM edema was present in 75% of MRIs performed within one month of Onyx treatment and may represent a possible etiology for seizures. New onset seizures post-Onyx embolization are not uncommon. Further study of seizure prevention is warranted.

Lower Risk of Intracranial Arteriovenous Malformation Hemorrhage in Patients With Hereditary Hemorrhagic Telangiectasia

Neurosurgery ◽  
2015 ◽  
Vol 78 (5) ◽  
pp. 684-693 ◽  
Author(s):  
Wuyang Yang ◽  
Ann Liu ◽  
Alice L. Hung ◽  
Maria Braileanu ◽  
Joanna Y. Wang ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Clinical Manifestations ◽  
Intracranial Arteriovenous Malformation ◽  
Hemorrhagic Risk ◽  
History Of ◽  
Ruptured Avm ◽  
Martin Grade ◽  
Lost To Follow Up

Abstract BACKGROUND: Patients diagnosed with hereditary hemorrhagic telangiectasia (HHT) are at risk of developing intracranial arteriovenous malformations (AVM). However, the clinical manifestations and natural history of HHT-related AVMs remain unclear due to the rarity of these lesions. OBJECTIVE: To clarify the clinical characteristics and hemorrhagic risk in HHT-related AVMs. METHODS: We performed a retrospective review of all patients diagnosed with both HHT and intracranial AVMs who were evaluated at our institution from 1990 to 2013. Patients with missing data or lost to follow-up were excluded. Baseline characteristics and subsequent hemorrhagic risk were evaluated. RESULTS: In an AVM database of 531 patients with 542 AVMs, a total of 12 HHT patients (2.3%) with 23 AVMs were found. Mean age at diagnosis was 36.5 years, with 41.7% male. Compared to patients with sporadic AVMs, patients with HHT were less likely to present with ruptured AVM (P = .04), headaches (P = .02), and seizures (P = .02), and presented with better modified Rankin scores (P &lt; .01). HHT-related AVMs were smaller in size (P &lt; .01), of lower Spetzler-Martin grade (P = .01), and had less temporal lobe involvement (P = .02) compared to sporadic AVMs. Six HHT patients (50.0%) were found with multiple intracranial AVMs. One hemorrhage was found during an observation period of 149.6 patient-years and 297.5 lesion-years, translating to 1.3% per patient per year or 0.7% per AVM per year. CONCLUSION: HHT-related AVMs are smaller in size with lower Spetzler-Martin grade and less temporal lobe involvement than sporadic AVMs. Patients with HHT frequently present with multiple intracranial AVMs. Conservative management is generally recommended due to lesion multiplicity and relatively low hemorrhagic risk.

scholarly journals NORWEGIAN SCABIES IN AIDS PATIENT: A CASE REPORT

2016 ◽  
Vol 6 (2) ◽  
pp. 49
Author(s):  
Indropo Agusni
Keyword(s):  
Skin Infection ◽  
Clinical Manifestations ◽  
Sarcoptes Scabiei ◽  
Clinical Findings ◽  
Chief Complaint ◽  
History Of ◽  
Previously Treated ◽  
Almost All ◽  
Histopathology Examination ◽  
Thick Crust

Scabies is a skin infection caused by Sarcoptes scabiei var. hominis. This disease may present severe clinical manifestations in immune-compromised patient, well-known as Norwegian scabies or crusted scabies.A 36-year old man with AIDS had chief complaint thick crust almost all over his body in this case. History of household member infected by scabies before was present. Clinical findings show hyperpigmented macules unsharply marginated, covered with thick scales and accompanied by papules, fissures, and erotion. T cell CD4 level was 12 cell/ µL. Scraping examination showed scabies infection and so did the histopathology examination. This patient was treated by topical Permethrin 5% combined with 2-4 ointment application in between permethrin usage. Before topical scabicide was given, thick crust was previously treated by topical urea 10% and wet dressing by normal saline. On day 14 after the patient first came there was lesion improvement.

FDA analysis of patients with baseline autoimmune diseases treated with PD-1/PD-L1 immunotherapy agents.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3018-3018 ◽  
Author(s):  
Chana Weinstock ◽  
Harpreet Singh ◽  
Virginia Ellen Maher ◽  
Geoffrey Kim ◽  
Richard Pazdur
Keyword(s):  
Clinical Trial ◽  
Autoimmune Disease ◽  
Autoimmune Diseases ◽  
Safety Data ◽  
Clinical Manifestations ◽  
Thyroid Disorder ◽  
Multiple Tumor ◽  
Relative Safety ◽  
History Of ◽  
Grade 3

3018 Background: With FDA approval of three novel agents targeting the PD-L1/PD-1 checkpoint pathway in multiple tumor types, use of these agents in the clinical setting is becoming increasingly common. However, little is published on their use in patients with a history of autoimmune diseases. We therefore aimed to collect safety data on patients with a history of autoimmune diseases treated with PD-1/PD-L1 immunotherapy agents in a clinical trial setting. Methods: Data on patients with a history of autoimmune disease were collected for four different PD-1/PD-L1 immunotherapy agents. Information collected included name of autoimmune disease, corticosteroid dependency at baseline, duration of dosing, immune-related adverse events (iRAEs) and worsening of underlying autoimmune disease. Results: In total, 552 patients enrolled in 22 clinical trials of PD-1/PD-L1 immunotherapy agents were identified with a history of autoimmune disease. None were known to be dependent on systemic corticosteroids at baseline. The most common autoimmune diseases identified were thyroid disorder (n = 188), psoriasis (n = 70), and vitiligo (n = 44). For the four agents identified, mean duration of dosing was 183, 187, 196, and 145 days. Worsening of underlying autoimmune disease occurred in 16%, 6%, 13% and 6%. There were two grade 4 cases of hyperglycemia in patients with diabetes, three cases each of grade 3 AEs related to the underlying disorder in patients with psoriasis, interstitial lung disease, and hypothyroidism, and one grade 3 AE in a patient related to ankylosing spondylitis.For two of these agents, data were available on the development of grade 1-4 irAEs (per investigator) that required treatment with systemic steroids, which occurred in 8% and 9% of patients. Conclusions: Clinical trial data demonstrates relative safety of the use of PD-1/PD-L1 immunotherapy agents in patients with a history of autoimmune disease compared to their use in patients without such history. No consistent pattern of worsening of baseline autoimmune disease was identified. These results should be interpreted with caution, as diagnostic method and clinical manifestations of reported baseline autoimmune conditions are not known.

scholarly journals Acute surgical management of children with ruptured brain arteriovenous malformation

2021 ◽  
pp. 1-9
Author(s):  
Sarah Stricker ◽  
Grégoire Boulouis ◽  
Sandro Benichi ◽  
Marie Bourgeois ◽  
Florent Gariel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Arteriovenous Malformation ◽  
Intracranial Hypertension ◽  
Volume Ratio ◽  
Brain Arteriovenous Malformation ◽  
Decompressive Hemicraniectomy ◽  
Point Increase ◽  
Additional Surgery ◽  
Ruptured Avm ◽  
Martin Grade

OBJECTIVERupture of brain arteriovenous malformation (AVM) is the main etiology of intracerebral hemorrhage (ICH) in children. Ensuing intracranial hypertension is among the modifiable prognosis factors and sometimes requires emergency hemorrhage evacuation (HE). The authors aimed to analyze variables associated with HE in children with ruptured AVM.METHODSThis study was a single-center retrospective analysis of children treated for ruptured AVM. The authors evaluated the occurrence of HE, its association with other acute surgical procedures (e.g., nidal excision, decompressive hemicraniectomy), and clinical outcome. Variables associated with each intervention were analyzed using univariable and multivariable models. Clinical outcome was assessed at 18 months using the ordinal King’s Outcome Scale for Childhood Head Injury.RESULTSA total of 104 patients were treated for 112 episodes of ruptured AVM between 2002 and 2018. In the 51 children (45.5% of cases) who underwent HE, 37 procedures were performed early (i.e., within 24 hours after initial cerebral imaging) and 14 late. Determinants of HE were a lower initial Glasgow Coma Scale score (adjusted odds ratio [aOR] 0.83, 95% CI 0.71–0.97 per point increase); higher ICH/brain volume ratio (aOR 18.6, 95% CI 13–26.5 per percent increase); superficial AVM location; and the presence of a brain herniation (aOR 3.7, 95% CI 1.3–10.4). Concurrent nidal surgery was acutely performed in 69% of Spetzler-Martin grade I–II ruptured AVMs and in 25% of Spetzler-Martin grade III lesions. Factors associated with nidal surgery were superficial AVMs, late HE, and absent alteration of consciousness at presentation. Only 8 cases required additional surgery due to intracranial hypertension. At 18 months, overall mortality was less than 4%, 58% of patients had a favorable outcome regardless of surgical intervention, and 87% were functioning independently.CONCLUSIONSHE is a lifesaving procedure performed in approximately half of the children who suffer AVM rupture. The good overall outcome justifies intensive initial management.

Value of cone beam computed tomography to evaluate complication of intracranial haemorrhage in endovascular treatment (evt): a case report

2019 ◽  
Vol 1 (1) ◽  
pp. 16-18 ◽  
Author(s):  
Norafida Bahari ◽  
Nik Azuan Nik Ismail ◽  
Jegan Thanabalan ◽  
Ahmad Sobri Muda
Keyword(s):  
Computed Tomography ◽  
Arteriovenous Malformation ◽  
Endovascular Treatment ◽  
Cone Beam Computed Tomography ◽  
Diagnostic Value ◽  
Cone Beam ◽  
Brain Arteriovenous Malformation ◽  
Embolic Materials

In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.

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