Management of posterior fossa arteriovenous malformations

Almeida, João Paulo; Medina, Roberto Doria; Tamargo, Rafael J.

doi:10.4103/2152-7806.152140

Cited by 18 publications

(11 citation statements)

References 27 publications

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“…They are angiographically seen as direct connections between arteries and veins without an intervening capillary bed and can have multiple feeder vessels. About 20%-25% develop aneurysms of the vessels, increasing the chances of an intracranial bleed [ 12 ]. Surprisingly, the size of the AVM does not seem to affect the risk of hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of a Large, Deceitfully Quiet Brainstem Arteriovenous Malformation Presenting Only as Dizziness

Rao¹,

Giron²

2020

Cureus

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Dizziness is one of the most frequent complaints encountered in the medical practice affecting 15%-20% of adults yearly, and can be challenging to assess. Most patients use dizziness as a non-specific term, and thus suffer prejudice from the physicians’ end and can be disregarded frequently. Dizziness can be a symptom of various diseases, some with sinister pathologies. We present a case of garden-variety vertigo that unfurled to be not-so-simple, emphasizing the importance of a thorough history and physical examination again even in the era of technology. A 32-year-old male patient with no past medical history presented with dizziness, later clarified as gradually progressive vertigo for two years, with unstable gait, dysarthria, and occasional diplopia. Physical examination found sustained nystagmus that changed direction with horizontal gaze, vertical nystagmus with upward gaze, dysarthria, and a wide-based ataxic gait. CT head without contrast revealed indeterminate hypodense areas in the left midbrain, pons, and cerebellar hemisphere. MRI brain identified a 2.8 x 3.4 x 4.2 cm Spetzler-Martin grade IV brainstem arteriovenous malformation (AVM) involving the left midbrain, pons, and cerebellum. Feeders were mostly from the posterior circulation, with three intranidal aneurysms, all draining into the deep venous system. The AVM was deemed inoperable, and the patient was treated with onyx embolization for two/three feeding vessel aneurysms. After treatment, the symptoms persisted, and the patient was diagnosed with major depressive disorder (MDD) six months after diagnosis, and was admitted a year later with suicidal ideation and substance use disorder. Brain AVMs are rare clinical entities that present in 0.1% of the population, mostly presenting as intracranial bleeds. When they do rarely present with isolated focal neurologic deficits, it has been attributed to a vascular steal phenomenon, hemorrhage, or a mass effect. The isolated findings of vertigo and dysarthria are highly non-specific; with such presentation, clinicians should consider etiologies under the realm of vertigo of central origin. An untreatable AVM reduces patients’ quality of life and has been linked to depression and anxiety, and thus patients may benefit from psychosocial therapy. Although preventing intracranial hemorrhage (ICH) is the primary concern with brain AVMs, the rest of the patient’s profile should not be forgotten.

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Section: Discussionmentioning

confidence: 99%

A Rare Case of a Large, Deceitfully Quiet Brainstem Arteriovenous Malformation Presenting Only as Dizziness

Rao¹,

Giron²

2020

Cureus

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“…Headache, which he had not had ever, might be a sole cue for correct diagnosis. Hemorrhages in AVM may present as parenchymal, subarachnoid or intraventricular [1]. Minor hemorrhages around the nidus, probably from the posterior inferior cerebellar artery or anterior inferior cerebellar artery, might cause his symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Arteriovenous malformation (AVM) in the posterior cranial fossa is commonly presented with infratentorial hemorrhages [1]. Hemorrhages may present as parenchymal, subarachnoid or intraventricular.…”

Section: Introductionmentioning

confidence: 99%

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A case of cerebellar arteriovenous malformation presented with vertigo, hearing loss, and headache

Komiyama

Murofushi

Yoshimura³

2017

Acta Oto-Laryngologica Case Reports

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We report a 48-year-old man presented with episodic rotatory vertigo accompanied by right hearing loss and headache. He did not have medical history of migraine. His hearing loss was progressive. He showed unilateral (right-sided) absence of cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) to the right ear stimulation, while his caloric tests were normal on both sides. His signs and symptoms were suggestive of right peripheral vestibular vertigo except for headache. MRI revealed cerebellar arteriovenous malformation (AVM). Headache might be a sole cue for correct diagnosis. On the diagnosis of vertigo patients with headache, vertigo associated with secondary headache must be considered. ARTICLE HISTORY

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“…Posterior fossa arteriovenous malformations (AVM) represent 10 to 15% of all AVMs, whereas cerebellar AVMs represent around the 75% of all posterior fossa AVMs. 1,2 The most frequent clinical presentation is hemorrhage in around 60 to 80% of the cases, which may present as parenchymal, intraventricular, or subarachnoid.…”

Section: Introductionmentioning

confidence: 99%

Single-session Curative Embolization of Unruptured Cerebellar Arteriovenous Malformation with Precipitating Hydrophobic Injectable Liquid

Saal‐Zapata

Valer

Rodríguez

2020

Indian Journal of Neurosurgery

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Microsurgery is the treatment of choice for cerebellar arteriovenous malformations (AVMs). Nevertheless, endovascular therapy aims to be an effective treatment since the introduction of new embolic agents. Cerebellar AVMs represent a subgroup of vascular lesions with a high rate of hemorrhagic presentation compared with their cerebral counterpart. Moreover, they have a higher incidence of flow-related aneurysms when diagnosed. With this in mind, prompt treatment must be performed to avoid rebleeding with devastating consequences. Herein, we present the case of an unruptured cerebellar AVM treated with precipitating hydrophobic injectable liquid (PHIL) with complete obliteration.

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Management of posterior fossa arteriovenous malformations

Cited by 18 publications

References 27 publications

A Rare Case of a Large, Deceitfully Quiet Brainstem Arteriovenous Malformation Presenting Only as Dizziness

A Rare Case of a Large, Deceitfully Quiet Brainstem Arteriovenous Malformation Presenting Only as Dizziness

A case of cerebellar arteriovenous malformation presented with vertigo, hearing loss, and headache

Single-session Curative Embolization of Unruptured Cerebellar Arteriovenous Malformation with Precipitating Hydrophobic Injectable Liquid

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