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Idiopathic dural arteriovenous malformation which occurs in the posterior fossa uses predominantly transverse and sigmoid sinuses. Cavernous sinus comes next and others are rather rare. However, we have recently experienced such a rare case which was operated on and cured completely. The malformation was fed through the anterior ethmoid artery and drained to the cortical vein. The case was a 36-year-old male and admitted in our clinic for having headache and nausea as the chief complaints. He was diagnosed subarachnoid hemorrhage due to the following findings: CT scans showed a high density zone localized in the sylvian vallecula. Cerebrospinal fluid obtained by a lumbar puncture was found to be bloody. No neurological abnormality other than neck stiffness and positive Kernig's sign was observed. Under study of right carotid arteriography, dural AVM was evident. The anterior ethmoidal artery which branched out from the ophthalmic artery fed the AVM. The cortical vein which ran on the surface of the frontal base was its drainer via a small nidus. There was no abnormality seen on a left carotid arteriogram. Surgery was proceeded with the right frontal craniectomy in extra- and intradural approach. At first, anterior ethmoidal artery was cut at the cribriform plate extradurally. After dura was incised, both the nidus and drainer were coagulated intradurally. The nidus was located at inner surface of the dura. The arachnoid hemorrhage was thought to be caused by rupture of this drainer.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Dural arteriovenous malformation of the anterior fossa with subarachnoid hemorrhage]. 380 1

A 59-year-old man was admitted because of frequent vomiting and obtundation in February 1982. Neurological examination on admission revealed only slight impairment of consciousness. Papilledema, meningeal irritation sign and paralysis were not elicited. The plain CT scan was normal, but the CT scan with contrast material showed patchy enhancement in the left temporal lobe and around the third ventricle. Cerebral angiography showed a dural arteriovenous malformation (dural AVM) in the left transverse sinus fed by the left occipital artery, and the retrograde flow into the straight sinus. By the third day following admission, the level of consciousness became alert. The patient did not complain of headache, bruit and visual disturbance. He showed mild disorientation and memory disturbance. But his ordinary daily-living was independent. In August 1982, the patient gradually became inactive and apathetic. At times he lay in bed with moving his eyes, swallowing foods. At other times, he lay in bed with closing his eyes, immobile, and unresponsive except to strong painful stimuli. The patient was incontinent and required nursing care. During three month periods, the patient progressively became somnolent, speechless and immobile. Eventually, he was in a state of akinetic mutism. The patient became unresponsive. The state of consciousness fluctuated within a narrow range. The pupils were isocoric and did not react to light. He sometimes moved his eyes horizontally, but the vertical eye movement was limited. Deep tendon reflexes were hyperactive with Babinski reflex bilaterally. Passive mobilization of extremities revealed hypertonic. The CT scan disclosed the bilateral symmetrical infarction of the thalamus.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of dural arteriovenous malformation with bilateral thalamic infarction]. 381 31

The presence of intracranial aneurysm in association with arteriovenous malformation has been well documented. Aneurysms have been described in typical proximal sites along the feeding system to the arteriovenous malformation, in abnormal distal locations along feeding vessels, and in sites remote and apparently hemodynamically unrelated to the arteriovenous malformation. Little attention has been focused on the most appropriate medical and surgical care of patients harboring these lesions. Since 1977, 22 patients with this combination of lesions have been evaluated at our institution. Nine patients (41%) presented after intracranial hemorrhage. The remaining 13 patients were investigated because of seizures in 5 patients (23%), headaches in 4 patients (18%), and progressive ischemia in 4 patients (18%). Among the patients suffering intracranial hemorrhage, 78% had bled from an aneurysm, with 22% having hemorrhaged from their arteriovenous malformation. All 7 of the patients who suffered aneurysmal hemorrhage bled from atypical distal aneurysms on major feeding vessels. Our experience and that of others has led us to believe that the safest approach to patients with this combination of lesions is to treat the aneurysm before microsurgical resection of the associated arteriovenous malformation. Hemodynamic changes associated with the abrupt elimination of an arteriovenous malformation may place associated aneurysms at immediate risk.
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PMID:Intracranial arteriovenous malformations associated with aneurysms. 394 76

Nidus embolization of large arteriovenous malformation (AVM) by silastic spheres is not rarely performed prior to surgical excision of AVM. This technique is highly indicated for the large AVM supplied by the middle and the posterior cerebral arteries since silastic spheres injected into either the internal carotid or the vertebral arteries usually enter the middle or the posterior cerebral arteries due to less sharp angle from the main arteries. The authors report a case whose AVM, fed mainly by the anterior cerebral artery, was successfully embolized with silastic spheres using balloon catheter technique. On December 1, 1983, a 27-year-old man was admitted to our department with chief complaint of headache and clonic convulsion of the left upper and lower limbs. Convulsion began in 1973 and severe headache suddenly appeared two months prior to admission. He was neurologically asymptomatic on admission. Right internal carotid angiogram taken on admission showed a presence of large arteriovenous malformation in the medial portion of the right fronto-parietal lobe and corpus callosum fed mainly by the right pericallosal artery. Nidus embolization with silastic spheres was planned to make surgical removal easier. To prevent stray of silastic spheres into the right middle cerebral artery, balloon, introduced into the M1, was inflated for a few minutes, during which time, injection of 40 silastic spheres of 1.5 and 2.0 mm in diameter was performed via the right internal carotid artery. The nidus was significantly reduced and total removal of the nidus was successfully done 28 days following the embolization.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Nidus embolization of cerebral arteriovenous malformation fed mainly by a pericallosal artery prior to surgical excision. Case report]. 406 14

The patient was first admitted on August 19, 1975 with 5 years' headache and tinnitus. Physical examination revealed bruit over the left mastoid area. Left angiography, performed in August, 1975, revealed a dural arteriovenous malformation, which was supplied by enlarged left middle meningeal artery, occipital artery, meningohypophyseal artery and superior cerebellar artery and was draining into the left sigmoid sinus. At the first operation, the left external carotid artery was ligated at the neck, and then coagulation of dural vessels was performed through left temporo-occipital craniotomy. Tinnitus and bruit were disappeared after operation. Postoperative right angiogram showed no residual dural AVM, however, ligation of the right external carotid artery was required to reduce symptomes. In June, 1979 the left brachial arteriography was performed, and revealed a dural AVM around the left sigmoid sinus supplied by anastomotic vessels between external carotid artery and cervical artery arising from the vertebral artery. Because of subarachnoid hemorrhage, repeated angiography in April, 1982, revealed progressively enlarging dural AVM, although no aneurysm was seen in the left internal carotid arterial system. The patient readmitted on October, 28, 1983 with severe headache and confusion. CT scan showed slightly high density in the left basal cistern. Angiogram showed no dural AVM and a saccular aneurysm arising from the left internal carotid artery at C2 portion, which was successfully clipped by surgery. Only two cases of spontaneous regression of dural AVM in the posterior fossa were reported previously, and the authors added a case, which showed a newly developed aneurysm after spontaneous regression of the posterior fossa dural AVM.
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PMID:[Internal carotid aneurysmal formation following spontaneous regression of the dural arteriovenous malformation in the posterior fossa--a case report]. 408 44

The authors report a case of mixed pial-dural arteriovenous malformation (mixed pial-dural AVM), which had feeders from both cortical branches of the internal carotid artery and middle meningeal artery of the external carotid artery. A clinical course of this case is presented and literatures are reviewed. Moreover the authors stress the rete mirabile anastomoses as an important factor in the genesis of the mixed pial-dural AVM. The patient, 30-year-old female, suddenly suffered from a severe headache on December 31, followed by gradual deterioration of consciousness. She was admitted to Otaru Second City Hospital one hour after the episode and neurological examination disclosed moderate confusion, right hemiparesis and neck stiffness. CT scan revealed a massive hematoma in the bilateral ventricles and left parietal lobe and skull plain film showed an enlargement of the groove of the middle meningeal artery. Angiography revealed a mixed pial-dural AVM in the left parietal lobe, which had feeders from both cortical branches of the left internal carotid artery and middle meningeal artery of the left external carotid artery. Two weeks later the admission, an operation was performed. A ligation of the external carotid artery at the neck was performed before a craniotomy, and the bleeding from the dura was minimal, and the AVM in the parietal lobe was removed completely. The patient recovered satisfactorily without any trouble and she was discharged with only a mild weakness at the right side. The clinical finding of the mixed pial-dural AVM is discussed and the rete mirabile anastomoses is emphasized as an important factor in the genesis of the mixed pial-dural AVM.
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PMID:[Mixed pial-dural arteriovenous malformation. Case report]. 646 43

A 65-year-old woman with known breast carcinoma developed headaches, followed shortly by disequilibrium, vertical diplopia and dysarthria. Cranial computerized tomography (CCT) demonstrated a dense, irregularly enhancing pontine lesion with associated mass effect. She received dexamethasone (Decadron) and radiotherapy and subsequently expired. Postmortem examination disclosed a ruptured brain stem arteriovenous malformation within a massive hemorrhage along with necrotic atypical cells suggestive of metastatic disease.
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PMID:Brain stem vascular malformation simulating a hemorrhagic metastasis: report of a case with pathologic correlation. 648 86

Papilledema as a presenting sign of arteriovenous malformation without evidence of a space-occupying lesion or hydrocephalus is an unusual finding. The pathogenetic theory that seems to explain such cases is the increase of cerebral blood volume leading to intracranial hypertension, thus resulting in papilledema. We present the case of a 31-year-old woman complaining of headaches, with papilledema as the only objective finding. Computed tomography scan and right carotid angiography demonstrated a right mid rolandic arteriovenous malformation. The lesion was totally removed under intraoperative angiographic control.
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PMID:Cerebral arteriovenous malformation: papilledema as a presenting sign. 649 63

To define more closely the clinical relationship between migraine and intracranial arteriovenous malformation (iAVM), the clinical features of 57 reported instances and of 7 personal cases were analysed. Migraine attacks symptomatic of AVM include: late onset, frequent absence of (familial) migraine history, diminution or even inversion of the usual sex-ratio in migraine, brevity of attacks, disruption of the usual sequence of attack symptoms and, finally, unusual or permanent neurologic deficit. An attempt has also been made to clarify the epidemiological relationship. The reported frequency of migraine in cases of AVM, and AVM in cases of migraine is reflected against an inquiry into the number of annually diagnosed cases of AVM in 20 Dutch neurological/neurosurgical centres, covering 12.10(6) inhabitants in 8 of the 11 provinces. The annual incidence of migraine is estimated at 1:3,500 population, that of diagnosed iAVM is 120, i.e. 1:100,000. Coincidental occurrence of the two conditions works out at 1:4 X 10(8) per year. The presented case series of 7 seen in 2 of the 20 centres strongly militates against such a chance hypothesis.
Cephalalgia 1984 Sep
PMID:Intracranial arteriovenous malformation and migraine. 649 34

Rarely, a lesion simulating a colloid cyst of the third ventricle may present with obstructive hydrocephalus and headache. Experience with an arteriovenous malformation in this location is discussed.
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PMID:A case of arteriovenous malformation of the third ventricle: a clinical presentation and special features. 654 37


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