Intracranial arterial and arteriovenous malformations presenting with infarction. Lausanne Stroke Registry study*

Abstract

Cerebral aneurysms and arteriovenous malformations (AVMs) are well-known sources of intracranial hemorrhage, but can also manifest as other clinical symptoms or remain clinically asymptomatic. The aim was to document and analyze cases of aneurysm or AVM with brain infarction. Survey on 4804 stroke patients treated at the Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland between 1978 and 2000 using the Lausanne Stroke Registry. Twenty patients presented with cerebral aneurysm and 21 with cerebral AVM. Hemorrhage was present in 100% of the AVM and in 75% of the aneurysm patients; in one (5%) of the remaining aneurysm patients, aneurysm and infarction were located in different territories. Infarction associated with Sylvian artery aneurysm was found in three (15%), vertebrobasilar ischemia because of fusiform left vertebral artery aneurysm in one (5%), and dural fistula draining to the distal transversal and left sigmoid sinus associated with a stroke in the territory of the left anterior inferior cerebellar artery in one patient. Ischemic stroke is infrequent, but important, complication in unruptured intracranial aneurysms and AVMs. The early recognition and therapy of these vascular malformations in selected patients can avoid a major neurological deficit or death caused by their rupture.

Territorial and Microvascular Perfusion Impairment in Brain Arteriovenous Malformations

“…7,[13][14][15]21,22 Guo et al 13 reported a perinidal steal in brain AVMs and described 3 types of perfusion disturbance. In type 1, CBF and cerebral blood volume (CBV) ratios were increased in the immediate and remote perinidal regions.…”

“…The absence of perifocal CBF abnormalities in previous studies may be due to shortcomings in previous imaging methods with lower spatial resolutions. 7,15 It has been suggested that reduced arterial and raised venous pressures in AVM feeders are sufficient to compromise resting-state CBF adjacent to the AVM. 23 The inhomogeneous effect of the macrovascular AVM flow on the perfusion within the territory of the feeding artery in our study confirms such a second level of local perfusion impairment.…”

“…13,14 The problems encountered by using PET and SPECT to evaluate perinidal brain are due to their comparatively low spatial resolution, which requires that structures in the direct vicinity of the nidus be subject to the effects of partial voluming. 7,15 Previous dynamic susceptibility contrast-enhanced brain perfusion MR imaging studies in patients with brain AVMs overcame some of these drawbacks but revealed conflicting results: One study found no abnormalities in most patients, 14 whereas another group was able to discriminate 3 different types of perinidal perfusion disturbances. 13 However, the ability of this technique to assess perinidal perfusion is limited in the vicinity of large vessels and the nidus due to artifacts caused by contrast media within vascular structures and the changes it induces in the local magnetic field.…”

The Impact of Atherosclerotic Factors on Cerebral Aneurysm Is Location Dependent: Aneurysms in Stroke Patients and Healthy Controls

“…UIAs are incidentally found when a brain MRA is performed in asymptomatic healthy volunteers 6,7 ; UIAs in stroke patients are also incidentally detected 2,5,6,[8][9][10] . Some previous studies indicated that cerebrovascular diseases seem to increase the occurrence of UIAs 5,11 .…”

The Hemodynamic Changes in Patients with Cerebral Arteriovenous Malformations before and after Interventional Embolization Therapy with Glubran 2 Acrylic Glue

“…Cerebral arteriovenous malformation (CAVM), which is a common intracranial vascular deformity, is a well-known cause of intracerebral, intraventricular, and subarachnoid hemorrhage and other clinical symptoms [1]. CAVM occurs due to lack of direct fistula between the cerebral arteriovenous capillaries, which lead to the appearance of arteriovenous short-circuit and cause arteriovenous direct connectivity that intrigues a series of abnormal hemodynamics manifested in various clinical symptoms and signs [2].…”