‘Steal’ Is an Unestablished Mechanism for the Clinical Presentation of Cerebral Arteriovenous Malformations

Abstract

Nonhemorrhagic focal neurological syndromes in AVM patients are infrequent. Progressive deficits are especially rare. There was no relation between feeding artery pressure or flow velocities and FND. There does not appear to be sufficient evidence to assign steal as an operative pathophysiological mechanism in the vast majority of AVM patients.

Angioarchitecture of Brain AVM Determines the Presentation with Seizures: Proposed Scoring System

“…[8][9][10] However, the actual existence of steal has been questioned because it has been difficult to demonstrate quantitatively. 7,11,12 Others have raised the possibility that seizures are more often related to a disrupted venous outflow pattern than to an inadequacy of arterial blood supply. [13][14][15][16][17] There are only a few studies that have examined the association between individual angioarchitectural characteristics of the BAVM and seizure presentation.…”

“…Chronic hypoxemia can lead to gliosis, which, in turn, may trigger epileptic activity. 7,11,12 The fistula may also be a marker for greater venous hypertension due to greater bulk flow into the draining vein.…”

Postoperative Hyperperfusion Associated With Steal Phenomenon Caused by a Small Arteriovenous Malformation-Case Report-

“…4) However, vasomotor paralysis is not responsible for this phenomenon and uncoupling of the CBF and metabolism is more likely to be the cause of reperfusion injury. 9,15) Our case of AVM manifested as hypoperfusion with normal vasoreactivity before surgery and stagnation of the main feeding artery with hyperperfusion after surgery. Strict blood pressure management and hypothermal treatment during and after the surgery, preoperative embolization, and staged operation are recommended to prevent complications.…”

“…13) Therefore, steal should possibly not be defined as cortical ischemia as a result of arterial hypotension. 9) Common clinical steal phenomena Postoperative Hyperperfusion Caused by a Small AVM such as progressive focal neurological deficits or impairment of higher cognitive functions are rather a consequence of neuronal deafferentation and diaschitic phenomena in distant regions of the brain. In our case, preoperative SPECT of the low perfusion area in the remote cortex fed by the main feeding artery demonstrated normal vasoreactivity to acetazolamide.…”

Recommendations for the Management of Intracranial Arteriovenous Malformations

“…Vascular malformation-related steal phenomena that cause focal neurological deficit by altering perfusion in the tissue in the region of the AVM are distinctly uncommon. 14,16 The overall frequency of hemorrhage caused by vascular malformations in stroke registries indicates an Ϸ1% occurrence of AVM-related hemorrhage among all strokes. 17 The long-term risk of hemorrhage among people with AVMs and the outcome from this hemorrhage are controversial.…”