Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

Ischemic myocardial damage was identified as a complicating feature in the clinical course of 12 newborn infants who died in congestive failure with cerebral arteriovenous malformation. Electrocardiograms of 11 patients showed signs of chamber hypertrophy and T wave and ST segment features of varying degree compatible with ischemia or infarction. Histological evidence of myocardial necrosis or infarction was detected in seven of the ten infants from whom autopsy material was still available.
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PMID:Cerebral arteriovenous malformation in neonates. The role of myocardial ischemia. 684 50

The objectives of this study were to evaluate the use of brain stem auditory evoked potentials (BAEPs) in 10 adult patients with vascular disorders of the posterior circulation that were treated surgically and to compare the BAEPs with the neurological findings. The vascular lesions included basilar artery stenosis in 3 patients, vertebral artery stenosis in 1 patient, brain stem/cerebellar arteriovenous malformation in 2 patients, and basilar artery aneurysm in 4 patients. Measurement of BAEPs were carried out during operation in all cases. Eight patients had BAEPs measured before operation, and 9 patients had BAEPs measured after operation. Repeat postoperative studies were performed in patients with changes in neurological status. In general, BAEP abnormalities correlated with the neurological findings before and after operation. Six patients had normal intraoperative studies. None of them had clinical findings of pontomesencephalic dysfunction after operation. Three patients with significant BAEP abnormalities during operation had neurological findings of pontomedullary ischemia after operation. Transient BAEP changes in 1 patient were thought to be the result of brain stem retraction. The BAEPs were lost in 3 patients who died. The use of BAEP measurement did not lengthen the operative procedures. However, the technique used in this study required 4 to 8 minutes for the accumulation and interpretation of each average, thereby delaying feedback to the surgeon. The results of this study suggest a potential role for BAEP monitoring in identifying brain stem injury during posterior circulation surgery.
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PMID:Brain stem auditory evoked potentials in posterior circulation surgery. 686 30

Despite advances in the surgical management of cerebral arteriovenous malformations (AVMs), giant (AVMs (greater than 5 cm] are still considered unsuitable for direct surgical resection by most neurosurgeons. Some of the lesions are being treated with embolization, or embolization followed by surgical excision. Embolization alone is not curative and carries potential risks of neurological deficit as well involves multiple procedures. Fourteen patients with giant AVMs underwent surgical resection without prior embolization. Four of the AVMs were located primarily in the frontal lobe, two in the temporal lobe, one each in the parietal and occipital lobes, while six AVMs were localized to two lobes (temporal-occipital or parietal-occipital). Four patients had associated aneurysms with the arteriovenous malformation. Eight patients presented primarily with seizures. One of these had multiple subarachnoid hemorrhages while another had symptoms suggestive of transient vertebrobasilar ischemia. Two patients had one or more subarachnoid hemorrhages. The primary complaint in the remaining four patients was headache with other associated symptoms. The patients with AVMs involving the optic radiation have had varying degrees of visual field deficit not interfering with their function. There were no deaths and only three patients had deterioration of neurological function. One of these three had an intra cerebral hemorrhage secondary to an associated aneurysm rupture. We feel that the majority of these giant AVMs are amenable to direct surgical excision. It is difficult to asses, from the literature, the benefit of embolization prior to surgical excision in cases of giant AVMs. At least in one report dealing with combined treatment of seven giant AVMs, some authors stressed that preoperative embolization did not significantly alter the blood flow and, hence, potential of bleeding at the time of operation. Blood loss has not been a significant problem in our experience. When there is an associated aneurysm, it should be treated prior to or at the time of excision of the malformation.
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PMID:[Surgical treatment of giant cerebral arteriovenous malformations]. 696 74

We report a patient with an unruptured, large arteriovenous malformation that was treated by staged, superselective embolization with liquid agents and by an investigation of the hemodynamic changes accompanying embolization. A 29-year-old man presented with headache and left upper quadrantanopsia. A neuroradiological study revealed a large right temporo-occipital arteriovenous malformation, and angiography disclosed poor filling of the adjacent vessels. In the venous phase, marked cortical reflux, suggesting venous hypertension, was also observed. Single photon emission computed tomography scanning with N-isopropyl-p-iodine-123- iodoamphetamine disclosed a low-perfusion area in the ipsilateral occipital and temporal lobes. After embolization, cerebral blood flow and the clinical symptoms attributed to ischemia improved. A follow-up study 1 year later demonstrated that the patient's improvement was stable. Single photon emission computed tomography confirmed that embolization achieves an improved cerebral blood flow.
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PMID:Improvement of cerebral blood flow and clinical symptoms associated with embolization of a large arteriovenous malformation: case report. 823 19

A case of dural arteriovenous malformation of the transverse sinus, is presented, with dural sinus occlusion imaged with gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA). The patient, a 59-year-old man, had developed easy forgetfulness and frequent misreading over a four-month period; he had had episodic vertiginous attacks since 3 January 1992. Magnetic resonance (MR) imaging done on 21 January 1992 showed abnormally dilated subcortical vessels and a non-hemorrhagic venous ischemia in the subcortical white matter of the left posterior temporal lobe. Thrombosis of the left sigmoid sinus was seen. After administration of intravenous Gd-DTPA, dense enhancement in the left sigmoid sinus and abnormal serpiginous enhancement in the left temporal lobe were revealed. Left carotid angiography showed dural arteriovenous malformation in the posterior fossa, with non-opacification of the left transverse and sigmoid sinuses, plus forward venous drainage into left superior petrosal sinus. The focal neurologic deficits in this case from non-hemorrhagic venous ischemia in the subcortical white matter of the left posterior temporal lobe, and were secondary to venous hypertension.
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PMID:Gadolinium-DTPA enhanced magnetic resonance imaging of dural sinus occlusion in dural arteriovenous malformation: a case report. 829 43

This report presents a patient with an intradural spinal arteriovenous fistula complicated by infarction of the cord. The diagnosis of an arteriovenous malformation was made on the magnetic resonance imaging (MRI) study with the demonstration of intraspinal serpentine areas of low signal intensity (flow voids). The presence of other MRI findings believed to represent spinal cord ischemia included multisegmental swelling of the cord associated with T1 and T2 prolongation and gadolinium enhancement. The location of the malformation, as well as arterial supply and venous drainage, were defined on selective spinal arterial digital subtraction angiography (DSA). Following surgical resection, the clinical condition stabilized, but with poor return of lost function. The repeat MRI 6 months after surgery demonstrated diffuse thoracic cord atrophy.
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PMID:MRI of intradural spinal arteriovenous fistula associated with ischemia and infarction of the cord. 843 51

Ninety-six patients with transient ischemia attacks were examined by transcranial Doppler (TCD), carotid color-coded ultrasonic imagine, brain computed tomographic scan (CT), compared with digital subtract angiography (DSA), MRI and MRA were done in some cases. The abnormality of CT and MRI was 30.2% and 74.1%, respectively. The most common findings were lacunar infarction or cerebral atrophy. Sixty-two cases fulfilled the TCD criteria of definitive arterial stenosis (64.5%) and three cases of arteriovenous malformation, among whom 27 patients (43.5%) carried out the examination of DSA. There was an excellent coincidence between the DSA and TCD findings, although DSA showed more vessels involved in some patients. Of the 96 cases, the intracranial arterial stenosis or occlusion was in 48.5% and the extracranial in 17.8%. The younger patients (age < 60 years) were subject to involvement of unilateral intracranial artery, but the older had predominantly the bilateral intracranial arterial and extracranial carotid or subclavian arterial lesions.
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PMID:[Intra- and extra-cranial arterial lesions in TIA patients]. 857 51

We report a unique case of thalamic dementia caused by tentorial dural arteriovenous malformation (AVM), which was successfully treated by surgical occlusion of the straight sinus after attempts to occlude the dural AVM by endovascular procedures had failed. The tentorial dural AVM was fed by bilateral posterior meningeal arteries and occipital arteries, with early retrograde venous drainage into the straight sinus, inferior sagittal sinus, basal vein of Rosenthal, and dural veins in the falx cerebri. The venous ischemia in bilateral thalamus was revealed as low-density areas in computed tomographic scans, as high-intensity areas in T2-weighted magnetic resonance images, and as decreased cerebral blood flow and increased cerebral blood volume in single-photon positron emission computed tomography. Because this patient was not amenable to cure by endovascular embolization, an open surgical approach, surgical occlusion of the draining venous channel (the straight sinus), was performed. Postoperatively, dural AVM in angiography and venous ischemia in bilateral thalamus were resolved, as revealed by magnetic resonance imaging and single-photon positron emission computed tomography. Dementia caused by bilateral thalamic ischemia was also resolved. This case clearly illustrates the pathophysiological mechanism of venous ischemia in the bilateral thalamus to cause reversible dementia.
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PMID:Reversible dural arteriovenous malformation-induced venous ischemia as a cause of dementia: treatment by surgical occlusion of draining dural sinus: case report. 858 60

The first case of a child with an arteriovenous malformation (AVM) associated with moyamoya disease is reported. The patient presented ischemic symptoms and underwent indirect bypass surgery on both sides when she was 5 years old. Four years later she suffered from headache, and a small AVM of the left frontal lobe associated with the moyamoya vessels was detected. Single photon emission computed tomography (SPECT) was performed at age 11 and demonstrated low local cerebral blood flow (CBF) in the left frontal lobe and right temporal lobe, although the revascularization after the bypass surgery seemed to be effective, as judged on pancerebral angiography. We feel that brain ischemia due to the moyamoya disease may have played a causative role in the development of the AVM.
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PMID:Arteriovenous malformation associated with moyamoya disease. 929 67


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