This  is a lateral Carotid Angiogram of a 17 year old boy who came  to the neurology clinic complaining of left sided  dull headache.And he has had two episodes of tingling sensation of his right arm.His  neurological examination was unevntful.


What is your diagnosis?


ANSWER

ARTERIOVENOUS MALFORMATION IN THE ANTERIOR CEREBRAL TERRITORY


Arteriovenous Malformation are lesions of the cerebral vasculature development such that blood flows directly from the arterial system to the venous system without passing through a capillary system.


The direct AV connection exposes the venous system to abnormally high pressures. This results in a system of enlarged feeding vessels, the tangled nidus of the AVM itself, and enlarged draining venous structures.


AVMs are considered congenital lesions.


Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) are thought to be responsible for the development of AVM

CLINICAL FEATURES

  1. Hemorrhage (ICH,SDH,IVH)
  2. Seizure
  3. Headache
  4. Progressive neurologic deficit - May be caused by mass effect or ischemia resulting from local vascular steal phenomenon
  5. If blocks the CSF pathway - Hydrocephalus


Hemorrhage is more likely to be caused by small lesions, while seizures are more likely to be caused by large lesions.

INVESTIGATIONS

  • Imaging
  • CT scan to exclude Intracranial haemorrhages
  • MRI
  • CT angiography better vascular detail than magnetic resonance angiography
  • Cerebral angiography provides definitive diagnosis. It allows grading of the AVM via the following Spetzler and Martin criteria.

TREATMENT

Surgery (craniotomy)
  • Advantages: immediate and permanent recovery after complete resection by craniotomy
  • Disadvantages: Intraoperative bleeding, damage to adjacent neural tissue, and ischemic stroke
  • Benefit of invasive treatment for unruptured AVMs has never been proven


Embolization
  • Occlusion of blood vessels with coils or particles or glue introduced by a radiographically guided catheter
  • An invasive procedure
  • Use it as adjuvant therapy prior to craniotomy to decrease intraoperative bleeding and reduce the size of AVM
  • Is Curative in lesions <1 cm in diameter that are fed by a single artery 


Stereotactic radiosurgery
  • Noninvasive 
  • Can access all anatomic locations of the brain 
  • It can only treat smaller lesions 
  • Takes 2 or more years for a full destructive effect

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18 comments

  1. Anonymous Says:
  2. Moyamoya disease?

     
  3. Anonymous Says:
  4. AVM in the left lobus frontalis

     
  5. Anonymous Says:
  6. end artery carotid aneurysm

     
  7. Arterio-venous malformation?

     
  8. Anonymous Says:
  9. ruptured cerebral aneurysm

     
  10. Anonymous Says:
  11. arash from iran

    there is contrast in sagital venous system in arterial phase of angiography , so the diagnosis is AVM

     
  12. Anonymous Says:
  13. arash from iran
    there is contrast in sagital venous system in arterial phase of angiography , so the diagnosis is AVM

     
  14. Anonymous Says:
  15. the contrast enter to the brain sinus network,and for young children highly suspecting of AVM

     
  16. Anonymous Says:
  17. ruptured aneurysm

     
  18. Anonymous Says:
  19. Arteriovenous Malformation, most common cause of SAH in young patients.

     
  20. Ashish Says:
  21. DR.P.S.N.Raju, UFWC ,Area Hospital , AKP, Vizag,India

    The central branches of the middle cerebral are the medial and lateral striata arteries. The striata supply the basal ganglia, internal capsules and thalamus. Because they are the main blood supply to the internal capsule, they are called by some the arteries of stroke. When something happens to these arteries, the bottleneck of fibers within the internal capsule can be damaged, causing many disabilities. The striata are very thin arteries and blood pressure within it high. For this reason, they are considered by many to be more vulnerable to hemorrhages than to blockages, although FitzGerald says that occlusion of one of these areteries is the major cause of of classical stroke where pyramidal tract damage results in contralateral hemiplegia.

     
  22. sharimi Says:
  23. arterio venous malformation,clear enough...

     
  24. dr.ainulwara Says:
  25. AV malformation looks like in ant. cerebral artery territory,,leakage can give such symptoms,chronic headaces,sensory or motor symptoms and visual disturbances

     
  26. Anonymous Says:
  27. AVM

     
  28. Indunil Says:
  29. what is the answer please?

     
  30. Bobbymurjani Says:
  31. Ya jelas AVM lah .... keliatan kok dari foto angiografinya..tul gak?

     
  32. Anonymous Says:
  33. ant cerebal AVM

     
  34. Anonymous Says:
  35. ant cereblar artery AVM

     

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