Targeted endovascular treatment of haemorrhagic posterior fossa proliferative angiopathy

Giragani, Suresh; Pavunesan, Santhosh Kumar; Balasubramaniam, Anandh

doi:10.1177/1591019918761640

Cited by 13 publications

(15 citation statements)

References 5 publications

(4 reference statements)

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“…Cerebral proliferative angiopathy (CPA), as described by Lasjaunias et al, differs from our case in that CPA is characterized by ''the small caliber of a multitude of feeding arteries and draining veins,'' 6 while our case involves abnormalities of the venous phase only and does not have arteriovenous shunting. More recent reports have also identified arteriovenous fistula, flow-related aneurysm, 7 and intracranial hemorrhage 7,8 in CPA, neither of which were observed in our patient. Leptomeningeal angiomatosis of SWS may have a similar radiographic appearance to our case.…”

Section: Other Entities With Abnormal Network Of Small Veinssupporting

confidence: 59%

Restrictive cerebral cortical venopathy: A new clinicopathological entity

et al. 2019

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We present a case of a novel restrictive cerebral venopathy in a child, consisting of a bilateral network of small to medium cortical veins without evidence of arteriovenous shunting, absence of the deep venous system, venous ischemia, elevated intracranial pressure, and intracranial calcifications. The condition is unlike other diseases characterized by networks of small veins, including cerebral proliferative angiopathy, Sturge-Weber syndrome, or developmental venous anomaly. While this case may be the result of an anatomic variation leading to the congenital absence of or early occlusion of the deep venous system, the insidious nature over many years argues against this. The absence of large cortical veins suggests a congenital abnormality of the venous structure. The child’s presentation with a seizure-like event followed by protracted hemiparesis is consistent with venous ischemia. We propose that this is likely to represent a new clinicopathological entity.

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Section: Other Entities With Abnormal Network Of Small Veinssupporting

confidence: 59%

Restrictive cerebral cortical venopathy: A new clinicopathological entity

et al. 2019

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“…Other findings are the paucity of draining vessels compared with the nidus size, proliferation of pial vessels, and presence of flow void -indicating vigorously flowing blood. The absence of acute infarcts or intracranial hemorrhages also supports this diagnosis, even though they can be present (2,7,10,14,19) .…”

Section: Diagnosismentioning

confidence: 82%

“…When hemorrhage is the target, partial embolization seems to be sufficient. Partial targeted embolization was employed and yielded progressive improvement in the case reported by Giragani et al, 2018, where the source of bleeding could be clearly identified (14) and also in a case series by Lasjaunias et al, 2008 (2) . Conversely, the same procedure aimed at reducing the shunt vascularity lead to symptom recurrence and neurological decline (3) .…”

Section: Treatmentmentioning

confidence: 95%

“…Transitory ischemic attacks, loss of consciousness or progressive neurological deficits, including speech and gait abnormalities, are also commonly seen across case reports (6 -13) . Acute neurological deficit or hemorrhage are reported, but are not the usual presentation (3,7,11,14) . Previous radiological findings postulate that the low risk of hemorrhage might be due to decreased intranidal blood pressure, related to proximal artery stenosis and longer mean time transit (MTT) -time that red blood cells spend within a determinate volume of capillary circulation.…”

Section: Clinical Coursementioning

confidence: 99%

“…A diffuse network of densely enhancing vascular spaces with intermingled normal brain parenchyma might be considered an essential finding across series of cases and case reports to emit a diagnosis of CPA (Figure 1). Lesions are usually large and profound, compromising multiple lobes, whole hemispheres or even both sides of the brain, with extension to basal ganglia and thalamus in 85% of cases, and with possible infratentorial impairment (2,7,10,14,19) .…”

Section: Diagnosismentioning

confidence: 99%

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Cerebral proliferative angiopathy: a review / Angiopatia proliferativa cerebral: uma revisão

Nunes

Santos

Aguiar

et al. 2019

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introduction: Cerebral Arteriovenous Malformations (AVMs) are vascular lesions defined by arteriovenous shunting flowing through a nidus of coiled and tortuous vascular connections. Cerebral Proliferative Angiopathy (CPA) is a rare type of AVM with pathological, clinical, diagnostic features and treatment differences from a typical AVM. We aimed to summarize important features of CPA already described and identify important gaps of evidence. Methods: Data was selected by a search of PUBMED with the term "cerebral proliferative angiopathy". The articles considered relevant were included in this review. We also screened article references and included them as needed. Discussion: CPA shows a diffuse nidus appearance, presence of transdural supply and stenosis of feeding arteries, without dominant feeders or flow-related aneurysms. There is intermingled brain between the vascular spaces. The usual clinical presentation is seizures, headaches, and progressive neurological deficits. Sound diagnosis can be made based on CT, MRI, Angiography and perfusion techniques, which are essential to treatment choices. Invasive treatment is seldom indicated, in order to preserve the normal brain parenchyma, and clinical control of symptoms, associated with a thorough follow-up, is the usual approach in most reported cases. Conclusion: Still much remains to be learned about CPA. Establishing more precise roles of various radiological assessing methods, how they affect the follow-up of patients, and safety and efficacy profiles of different treatment approaches will provide us the tools to give patients a more solid intervention and clearer follow-up.

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