The Relationship of Coexisting Extranidal Aneurysms to Intracranial Hemorrhage in Patients Harboring Brain Arteriovenous Malformations

Kim, Eui Jong; Halim, Alexander X.; Dowd, Christopher F.; Lawton, Michael T.; Singh, Vineeta; Bennett, John P.; Young, William L.

doi:10.1227/01.neu.0000124483.73001.12

Cited by 75 publications

(36 citation statements)

References 24 publications

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“…The diagnosis is made on the basis of clinical experience and inference, and it becomes clearer the farther the hemorrhage is spatially related to the nidus on the head CT scan obtained at presentation. 17 Correlations can then be made with angiographic studies, including superselective injections. Subarachnoid hemorrhage without associated intracerebral hemorrhage strongly implicates the IA as the possible source of the bleed (Fig 3).…”

Section: Treatmentmentioning

confidence: 99%

“…6,15,16 Discrepancies in the actual incidence are likely multifactorial, including patient population, use of superselective angiography, and the inclusion of intranidal aneurysms. 17 Intranidal aneurysms may, in fact, be visualized during embolization procedures as nidus obliteration progresses. In fact, according to one study, the interrater reliability for the diagnosis of coexisting aneurysms in patients with AVMs was only 40%.…”

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confidence: 99%

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Aneurysms Associated with Brain Arteriovenous Malformations

Rammos¹,

Gardenghi

Bortolotti³

et al. 2016

AJNR Am J Neuroradiol

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SUMMARY:Brain arteriovenous malformations are frequently associated with the presence of intracranial aneurysms at a higher-thanexpected incidence based on the frequency of each lesion individually. The identification of intracranial aneurysms in association with AVMs has increased due to improvement in diagnostic techniques, particularly 3D and superselective conventional angiography. Intracranial aneurysms may confer a higher risk of hemorrhage at presentation and of rehemorrhage in patients with AVMs and therefore may be associated with a more unfavorable natural history. The association of AVMs and intracranial aneurysms poses important therapeutic challenges for practicing neurosurgeons, neurologists, and neurointerventional radiologists. In this report, we review the classification and radiology of AVM-associated intracranial aneurysms and discuss their clinical significance and implications for treatment. ABBREVIATION: IA ϭ intracranial aneurysm

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Section: Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

Aneurysms Associated with Brain Arteriovenous Malformations

Rammos¹,

Gardenghi

Bortolotti³

et al. 2016

AJNR Am J Neuroradiol

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“…The British Journal of Radiology, July 2010 aneurysms should be treated as an independent risk factor [9]. All factors that contribute to venous hypertension are likely to increase the potential risk of intracerebral haemorrhage (ICH).…”

Section: S Chakraborty P Eldridge and H C Nahser E130mentioning

confidence: 99%

Cerebral haemorrhage from a remote varix in the venous outflow of an arteriovenous malformation treated successfully by embolisation

Chakraborty¹,

Eldridge²,

Nahser³

2010

BJR

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ABSTRACT. The ''spot sign '', described in 2007, has shown that a focal area of contrast extravasation within an intracerebral haematoma (ICH) can be correlated with haematoma expansion. Here we describe a case where time-resolved dynamic CT angiography (dCTA) shows the appearance of the ''spot sign'' only in later images. This shows the importance of timing of static CT angiogram that, if performed too early, might result in a false negative diagnosis. Haemorrhage in patients with intracranial arteriovenous malformation (AVM) usually occurs from the AVM itself or from an associated arterial aneurysm. We report a case of intracerebral haemorrhage arising from a remote varix related to the venous outflow of an ipsilateral frontal AVM. Case reportA 63-year-old male was admitted following a sudden onset of headache associated with neck stiffness and visual disturbances. There was no history of loss of consciousness or focal neurological deficit. On examination, the patient was photophobic and had nuchal rigidity. A visual field test showed a right homonymous hemianopsia but there were no other focal neurological signs.A non-enhanced CT of the brain ( Figure 1a) showed a large left temporal lobe intracerebral haemorrhage with secondary intraventricular and subarachnoid haemorrhage. There was also a calcified lesion in the left frontal lobe (Figure 1b), consistent with calcification within an AVM. A CT angiogram confirmed the presence of a left frontal AVM. An enhancing vascular structure adjacent to the left temporal lobe haematoma (Figure 1c) was demonstrated, representing either a flow aneurysm or a varix. MRI brain (Figure 1d) showed a left temporal intracerebral haematoma with an adjacent spherical area of flow void (Figure 1e), consistent with an aneurysm or varix. An AVM was noted in the left middle frontal gyrus (Figure 1d), distal from the area of haemorrhage. MR angiography (Figure 1f) showed enlarged arterial feeders arising from the left anterior and middle cerebral arteries.The conventional cerebral angiogram (Figure 2) confirmed the presence of a left frontal AVM (SpetzlerMartin grade 1-0-0) that was mainly supplied by branches of the left internal carotid artery. No arterial flow aneurysm was noted. The AVM had a peculiar way of draining. A primary single large collecting vein was divided into several smaller veins, majority of which were draining into the superior sagittal sinus via communication with superficial cortical veins. There was a single vein with a posteroinferior course. During late venous phase, two varices were seen on this vein (Figure 2c, f). Various degrees of stenoses were seen in the peripheral draining veins. The varix, adjacent to the area of haemorrhage, showed impaired outflow because of stenosed segments ( Figure 2f) and was probably the most vulnerable part of this AVM with regard to haemorrhage.During embolisation, the major right prefrontal middle cerebral artery feeder was initially catheterised and the tip of the microcatheter was placed intranidally within the AVM (Figur...

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“…In these cases, liquid embolism material is used to treat the region containing the aneurysms. the process of interventional treatment was successful in the five type IV aneurysms analyzed, and the prognoses were good 19,25 . two unruptured aneurysms were included in this study.…”

Section: Discussionmentioning

confidence: 89%

“…type II aneurysms originate from the start of the aVM's feeding artery, and are therefore considered to be flowrelated aneurysms. the feeding artery within the aVM lashes the vascular wall with high velocity blood flow, leading to saccular aneurysm formation 19 . of this kind of aneurysm, three were treated by coil.…”

Section: Clinical Outcomementioning

confidence: 99%

Endovascular Treatment of Intracranial Ruptured Aneurysms Associated with Arteriovenous Malformations: A Clinical Analysis of 14 Hemorrhagic Cases

Yang

Luo

et al. 2011

Interv Neuroradiol

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This study investigated and summarized endovascular therapeutic strategies for intracranial ruptured aneurysms associated with arteriovenous malformations (AVMs). Between June 2005 and June 2009, we identified 16 aneurysms in 14 hemorrhagic cases of intracranial AVM using digital subtraction angiography (DSA). Of the 16 aneurysms, 14 were ruptured and two were unruptured. Aneurysms were classified as types I to IV, and were treated. Aneurysm treatment was followed by AVM treatment via various therapies, including embolization, gamma knife radiotherapy, or follow-up and observation to reduce the risk of aneurysm rupture or intracranial hemorrhage. Over a follow-up period ranging from six months to one year, none of the patients had aneurysm ruptures or intracranial hemorrhage. Most (13/14) patients had a Glasgow Outcome Scale (GOS) score of 5, and one patient had a score of 4. Sixteen aneurysms were treated successfully, as confirmed by DSA examination, and no AVMs re-grew. Clinical therapeutic strategies for intracranial ruptured aneurysms associated with AVMs should include aneurysm treatment first to reduce the risk of rupture and intracranial hemorrhage, eventually leading to a better prognosis.

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The Relationship of Coexisting Extranidal Aneurysms to Intracranial Hemorrhage in Patients Harboring Brain Arteriovenous Malformations

Abstract: Clinical presentation with ICH was associated with EA aneurysms, but the association was due to aneurysmal rather than BAVM rupture, suggesting that EAs and the BAVM ICH risks may be considered as separate entities in future studies.

Cited by 75 publications

References 24 publications

Aneurysms Associated with Brain Arteriovenous Malformations

Aneurysms Associated with Brain Arteriovenous Malformations

Cerebral haemorrhage from a remote varix in the venous outflow of an arteriovenous malformation treated successfully by embolisation

Endovascular Treatment of Intracranial Ruptured Aneurysms Associated with Arteriovenous Malformations: A Clinical Analysis of 14 Hemorrhagic Cases

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