Wallace Mc

Superselective angiography of a spinal dural arteriovenous fistula having a common segmental origin with the artery of Adamkiewicz

SummaryThe artery of Adamkiewicz infrequently originates from the same radicular vessel that also supplies a dural arteriovenous fistula. This variant is not adequately emphasized in the neuroradiological literature. Awareness of this entity is essential to prevent catastrophic complication during embolization. We report such a case, and our experience with attempted, embolization. We are unaware of any previously reported instance of such an attempt being made.

Delayed angiography in the investigation of intracerebral hematomas caused by small arteriovenous malformations

We reviewed the clinical and radiological features of ten patients with small arteriovenous malformations that caused intracerebral hematomas. In six patients, angiography showed a small nidus (less than 1 cm in diameter) with a shunt at the site of the hematoma, and in four only an early-filling vein was evident. Six patients had only delayed angiography (4 weeks or more after the ictus). In three, angiography within 2 days of the ictus failed to reveal the cause of the bleed, but repeat angiography showed an early-filling vein in two, and a nidus with shunting in one. In only one patient did early angiography reveal the malformation. MRI was obtained in eight patients, and in two prominent vessels were evident in the wall of the hematoma cavity. In investigation of an unexplained intracerebral hematoma, MRI may be useful to exclude a neoplasm or cavernoma, although the latter may be not be evident in the presence of a recent hematoma. We suggest early MRI and angiography for investigation of an unexplained, nonhypertensive intracerebral bleed, with follow-up MRI and delayed angiography if the initial studies fail to reveal the cause.

Follow-up MR of Intracranial Cavernomas The Relationship between Haemorrhagic Events and Morphology.

The purpose of this review was to determine whether a classification scheme for cavernomas based on the MR appearance is predictive of the natural history of the lesions with particular reference to the risk of haemorrhage. We reviewed the clinical and MR findings in 156 patients with intracranial cavernomas. The dominant or symptomatic cavernoma was graded into three groups according to the appearance of the blood products. The presence of haemorrhage, mass effect and oedema was evaluated. Sixty patients had serial MRs with a mean follow-up of 1.9 years. Subacute haemorrhage with mass effect and oedema was evident on the initial MR in 30 patients (19%). In seven patients follow-up MR showed haemorrhage with mass effect and oedema. Six of these bleeds were in the posterior fossa. The haemorrhages seen on follow-up MR occurred in all three morphological types. Regression was found on follow-up MR in five of the seven patients who initially showed a bleed. In 35% of patients, the dominant or symptomatic cavernoma changed on serial MR. Intracranial cavernomas are dynamic lesions with both active and regressive changes seen on follow-up MR. A classification system based on morphology was not found to be useful in predicting future bleeds. Bleeding rates, based on MR follow-up, were 10.9% in the posterior fossa and 1.7% in the supratentorial compartment.

Palliative Embolisation of Brain Arteriovenous Malformations Presenting with Progressive Neurological Deficit

Large arteriovenous malformations (AVMs) located in eloquent areas of the brain are generally considered incurable because of the high morbidity and mortality associated with their treatment. When these patients develop a progressive neurological deficit they in time often become severely disabled. This report presents the results of palliative embolisation in this subgroup of patients. Analysis of our data-base of 714 patients with known brain AVMs revealed 17 patients who presented with progressive neurological deficit and who underwent palliative embolisation as the therapeutic modality of choice for management of their AVM. One patient was excluded due to lack of follow-up and two were excluded because they later received radiation therapy. Following embolisation 43% had improvement of their neurological deficit, 50% stabilized and 7% continued to deteriorate and these clinical results persisted for an average of more than 2 years follow-up. Transient neurological morbidity associated with embolisation treatment was 7% and there was no permanent morbidity and no mortality. Palliative embolisation of brain AVMs presenting with progressive neurological deficits arrested deterioration in more than 90% of patients and was associated with low morbidity and no mortality.