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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This retrospective study from two hospitals is about a hundred patients who have been operated upon a spontaneous cerebral hematoma. By a spontaneous cerebral hematoma we mean a hematoma without a proven tumor, without aneurysm, without arteriovenous malformation, without preceding trauma, without aortical phlebitis and without pathology of the vessel-wall. In this study patients with coagulopathy, arterial hypertension and artherosclerosis are included. In order to comply with these conditions an angiography will have to take place pre-operatively as well as postoperatively. Moreover histological examination of the wall of the hematoma will have to be done. The etiology of the spontaneous cerebral hematoma is not clear in most cases. The indication to operate, the way of operating and the moment in which the operation takes place, vary strongly in medical literature. We operate when there is an aggravation of the clinical picture, persisting severe headache and neurological paresis which does not improve. As a rule we abide for one week before operating, if the clinical picture allows this. After the operation unconscious patients may recover and a hemiparesis may improve. The best way of diagnosing a cerebral hematoma is computerised tomography.
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PMID:[The spontaneous cerebral hematoma (author's transl)]. 744 12

The authors encountered a rare case of sphenoidal ridge meningioma associated with an arteriovenous malformation in the same cerebral hemisphere. A 65-year-old female was admitted to our service because of headache. X-ray computed tomography (X-CT) and magnetic resonance image (MRI) disclosed a huge mass with peripheral edema, diagnosed as a sphenoidal ridge meningioma. An associated small mass was also noted in the right parahippocampal gyrus. This was confirmed by angiography as an arteriovenous malformation (AVM). During the waiting period for surgical treatment she had fallen into coma abruptly. Emergency X-CT revealed intracerebral and intraventricular hematomas. Both lesions were resected successfully in a one stage operation. Postoperative course was uneventful. In general, AVM located in the medial temporal lobe is difficult to approach. However, in this case, the resultant large cavity obtained after removal of meningioma afforded us easy access to the AVM.
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PMID:[Ipsilateral coexistence of AVM and meningioma: a case report]. 760 40

The authors report a case of dural arteriovenous malformation (dAVM) in the anterior fossa that was associated with an occlusion of the unilateral middle cerebral artery with Moyamoya phenomenon. The patient was a 79-year-old man referred to our department with an episode of consciousness disturbance and headache. Computed tomography scan showed intracerebral hematoma in the left frontal lobe, combined with left frontal subdural hematoma and subarachnoid hemorrhage. Angiography revealed dAVM in the left anterior fossa, fed by the bilateral ethmoidal and the bilateral middle meningeal arteries, and draining into the superior and inferior sinuses through the pial veins with vascular sacs. While angiography revealed an occlusion of the right middle cerebral artery (M1 portion) good collaterals via leptomeningeal anastomosis had developed. T1-weighted magnetic resonance (MR) images showed an intracerebral hematoma as a low intensity area, and flow-void areas were indicative of vascular sacs. Time-of-flight MR angiography also clearly showed dAVM in the left anterior fossa. Co-existence of an occlusion of an intracranial major artery and dAVM in this location has not been reported previously and it was speculated that this association had occurred by chance.
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PMID:[A case of dural arteriovenous malformation in the anterior fossa associated with an occlusion of the unilateral middle cerebral artery with moyamoya phenomenon]. 763 43

Thirty-one patients subjected to direct radical excision of a supratentorial arteriovenous malformation (AVM) participated in a comprehensive neuropsychological assessment both pre-operatively and at 4 and 12 months after surgery. The sample constitutes a consecutive series of patients who could complete the neuropsychological assessment before surgery. At the pre-operative assessment the mean results of all the tests fell very close to the average performance of age-equivalent normative samples. Postoperatively, the mean results showed a mild to moderate deterioration of performance on most cognitive and perceptual tasks by 4 months after surgery and a return approximately to the premorbid level by 12 months. Twelve of 15 patients with pre-operative epileptic seizures remained seizure free on medication during this first postoperative year, while two developed seizures de novo. Headache was cured or markedly reduced in all 16 patients incapacitated by headache prior to surgery. No definite emotional or affective changes after surgery were reported by the patients or their relatives. Comparison of pre-operative test results of patients with right-sided and left-sided AVM showed significant differences on five of 24 test parameters. Postoperatively, the number of statistically significant differences increased to nine test parameters at 4 months and ten at the 12-month assessment. The increase in number of statistically significant differences appears to reflect a moderate focal impact of the surgical intervention on cognitive functions in six of the 31 patients (19%). Postoperative improvement of test performance exceeding what may be ascribed to practice effects and chance fluctuations was only encountered in one patient. The present results therefore lend little empirical support to the so-called 'cerebral steal' hypothesis.
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PMID:Prospective neuropsychological investigation of patients with supratentorial arteriovenous malformations. 770 83

It is now recognized that spinal dural arteriovenous fistula causes myelopathy, resulting from congestive venous hypertension of the spinal cord. We have recently encountered a rare case of high cervical spinal cord dural arteriovenous fistula which caused intracranial subarachnoid hemorrhage. The patient was a 62-year-old female, who had exhibited an abrupt onset of severe headache and loss of consciousness. Plain head CT scan revealed intracranial subarachnoid hemorrhage. No abnormal vascular lesions were found on the first cerebral angiography. The second angiographical examination demonstrated a spinal arteriovenous malformation at the high cervical region. A dural arteriovenous fistula around the right C2 nerve root was found by surgical intervention. The fistula was recognized between rt. C2 radicular artery and dural sheath of rt. C2 nerve root, draining to the epidural plexus and intradural local medullary vein. No serpentine coronal venous plexus on the dorsal aspect of the cervical cord was seen as it is in a usual dural type of spinal arteriovenous fistula. The bleeding point was an intradural varix of the medullary vein just where it penetrated the nerve root area. Feeder ligation of the C2 radicular artery and coating of the varix complex were performed. The postoperative course was uneventful. The patient was discharged from our institute with no neurological deficits.
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PMID:[A rare case of high cervical spinal cord dural arteriovenous fistula presenting with intracranial subarachnoid hemorrhage]. 781 74

Congenital arteriovenous malformation (AVM) of the brain represents a defect in capillary development resulting in a high flow fistula between arterial and venous systems. In this study, AVM hemodynamics were related with clinical findings. Volume flow was calculated based on transcranial Doppler (TCD) and angiographic data. Forty patients admitted to the Massachusetts General Hospital for proton beam therapy (33 +/- 10 yr old; mean +/- SD) were studied. Four symptoms were considered: intracranial bleeding, progressive neurological deficit, seizures, and headache. Fourteen control subjects aged 30 +/- 7 years (mean +/- SD) were normal volunteers. Angiography with calibrated markers permitting magnification correction was available for all patients. Lateral and medial depth limits of the intracranial basal arteries in relation to the TCD temporal window were determined by TCD and angiogram with excellent correlation. Selected depth for data acquisition was determined independently in the angiogram and by TCD. The difference between the two techniques was less than 4 mm. Mean flow velocity, pulsatility index, and vessel diameter were studied. Flow volume was calculated from these data. Mean flow velocity, pulsatility index, vessel diameter, and flow volume were significantly different among AVM feeders, non-feeders, and control arteries. The non-feeding middle cerebral artery, anterior cerebral artery, and posterior cerebral artery flows were 254 +/- 13, 136 +/- 14, and 79 +/- 8 ml/min, respectively. Accordingly, the estimated cerebral flow volume was 938 ml/min. The feeding middle cerebral artery, anterior cerebral artery, and posterior cerebral artery flows were 552 +/- 47, 369 +/- 70, and 484 +/- 67 ml/min, respectively (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Arteriovenous malformation hemodynamics: a transcranial Doppler study. 790 93

A 29 year old woman suffered sudden hemiplegia, vomiting and headache during the 28th week of her first pregnancy. She was diagnosed as the intracranial hemorrhage due to the ruptured arteriovenous malformation, and emergency operation was performed. Anesthesia was induced with crush induction using thiamylal, fentanyl, pancuronium and suxamethonium, and maintained with fentanyl, isoflurane and nitrous oxide in oxygen. During and after surgery, fetal heart rate and uterine contraction were monitored continuously. Intense hypotension was not chosen because it may place a fetus at risk of intrauterine asphyxia. Ventilation was controlled to maintain PaCO2 between 30 and 35 mmHg. During surgery, D-mannitol 60 g was infused slowly to prevent fetal dehydration, and after surgery no osmotic diuretics were used. Ritodrine hydrochloride, which prevented premature delivery, was continuously infused after surgery. Her neurological symptom was improved and her baby was delivered vaginally at 41st gestational week.
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PMID:[Anesthesia for a pregnant patient with ruptured cerebral arterio-venous malformation]. 796 29

We report a 52-year-old man who had a 2-year history of right-sided occipitalgia. His pain was induced by anteroflexion of the neck. Neurologic examinations showed mild right C2 and C3 root signs. Cervical MR imaging disclosed an extra-medullary intradural crooked shadow at the level between C2 and C3 vertebrae, which was proven by selective angiogram of the ascending cervical artery to be a dural arteriovenous malformation located in the right C3 root sleeve. Embolization by an endovascular approach resulted in angiographic and clinical cure. These findings indicate that headache due to arteriovenous malformation in upper cervical region may be surgically treatable.
Headache 1994 Apr
PMID:Cervical dural arteriovenous malformation presenting with right-sided occipitalgia: before and after successful treatment by embolization. 801 42

We report a case of dural arteriovenous malformation (dAVM) in the anterior cranial fossa presenting with intracranial hemorrhage. The patient was a 60-year-old man who became unconscious shortly after developing an acute headache. Computed tomography performed on admission demonstrated a left frontal intracranial hematoma together with subarachnoid hemorrhage and a subdural hematoma. Cerebral angiography revealed a dAVM in the left anterior cranial fossa supplied by the anterior ethmoidal arteries bilaterally from enlarged ophthalmic arteries and which drained into the superior sagittal sinus via a dilated cortical vein with aneurysmal dilatation. The lesion was successfully resected via a left frontal craniotomy. Although reports of dAVMs in the anterior fossa are rare, a number of new cases have been described recently. The clinical features and angiographic findings in 58 cases are analyzed. The average age at the time the patients presented was 55.8 years, and males predominated (85.0%). Intracranial hemorrhage was the presenting manifestation in most cases (74.1%). Ocular symptoms occurred especially in cases with a posterior venous drainage pattern. Angiographically, the dAVM was most frequently supplied by the anterior ethmoidal artery (94.8%) and drained into a pial vein with vascular sac in almost every case. Rupture of this varicose dilatation often caused intracranial hemorrhage. The main drainage sinus or vein was usually the superior sagittal sinus (86.0%). The nidus was usually in the dura mater, but recently a nidus in the brain parenchyma has also been reported. The pathogenesis of this entity remains unclear, but some impairment of normal embryonic vascular development is the most likely etiology. Surgical resection remains the treatment of choice.
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PMID:[A case of dural arteriovenous malformation in the anterior cranial fossa presenting with intracranial hemorrhage]. 802 39

A case of dural arteriovenous malformation (DAVM) on the convexity adjacent to the superior sagittal sinus (SSS) was reported. A 55-year-old female was admitted to our hospital complaining of severe headache and intracranial bruit. CT scan revealed an osteolytic lesion at the right frontal bone adjacent to the SSS, and MRI showed a flow void area at the same site. Cerebral angiography detected DAVM which was fed by bilateral superficial temporal arteries and plenty of meningeal branches of the middle meningeal artery. It was drained by cortical veins to the SSS. Endovascular surgery was tried for this lesion, but it failed. After the surgical excision of DAVM, the above symptoms disappeared with no complications. The 14 cases reported in the literature were examined to characterize DAVM at this site. Average age was 47 with no age distribution. 43% of the cases had intracranial hemorrhage, subarachnoid hemorrhage (2), intracranial hemorrhage (2), intraventricular hemorrhage (1), and subdural hematoma (1). The DAVM arises most frequently at the middle third of the SSS and tends to extend to the posterior third. The symptom most frequently seen is headache, but we ought to pay attention to the possibility of progressive dementia. As for therapy, direct surgical excision is sometimes necessary if intravascular embolization ends in failure or incomplete cure.
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PMID:[A case of dural arteriovenous malformation on the convexity adjacent to the superior sagittal sinus]. 807 96


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