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Spontaneous partial regression of cerebral arteriovenous malformation.

Choi JH, Shin JH, Cho SS, Choi DL, Byun BJ, Kim DW - Korean J Radiol (2002 Jan-Mar)

Bottom Line: Arteriovenous malformation (AVM) of the brain is one of the important pathologic conditions which cause intracerebral or subarachnoid hemorrhage, epilepsy, or chronic cerebral ischemia.The spontaneous regression of cerebral AVM is reported to be very rare and more likely to occur when the AVM is small, is accompanied by hemorrhage, and has fewer arterial feeders.We report a case of right occipital AVM which at follow-up angiography performed four years later showed near-complete spontaneous regression.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 657 Hannam-dong, Yongsan-gu, Seoul 140-743, Korea. jhshin@hosp.sch.ac.kr

ABSTRACT
Arteriovenous malformation (AVM) of the brain is one of the important pathologic conditions which cause intracerebral or subarachnoid hemorrhage, epilepsy, or chronic cerebral ischemia. The spontaneous regression of cerebral AVM is reported to be very rare and more likely to occur when the AVM is small, is accompanied by hemorrhage, and has fewer arterial feeders. We report a case of right occipital AVM which at follow-up angiography performed four years later showed near-complete spontaneous regression.

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Follow-up CT scan and angiogram four years later without further treatment.A. Enhanced CT scan reveals marked regression, with a small residual AVM in the right occipital lobe and some encephalomalatic change at the site of the previous hematoma.B. Right vertebral angiography shows complete disappearance of the AVM in the right occipital lobe.C. Early-phase angiogram of the right external carotid artery depicts a residual AVM supplied by the right middle meningeal artery (arrows).D. Late-phase angiogram of the right external carotid artery shows the same draining vein (arrow) seen at initial vertebral angiography, which drains into the right transverse sinus (arrowhead). The disappearance of the previous proximal portion of the draining vein seen in Fig. 1D suggests thrombus formation.E. Photomicrograph (hematoxylin-eosin stain; magnification ×100) depicts an AVM composed of abnormal vessels of various sizes and with fresh intraluminal thrombi (arrows).
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Figure 2: Follow-up CT scan and angiogram four years later without further treatment.A. Enhanced CT scan reveals marked regression, with a small residual AVM in the right occipital lobe and some encephalomalatic change at the site of the previous hematoma.B. Right vertebral angiography shows complete disappearance of the AVM in the right occipital lobe.C. Early-phase angiogram of the right external carotid artery depicts a residual AVM supplied by the right middle meningeal artery (arrows).D. Late-phase angiogram of the right external carotid artery shows the same draining vein (arrow) seen at initial vertebral angiography, which drains into the right transverse sinus (arrowhead). The disappearance of the previous proximal portion of the draining vein seen in Fig. 1D suggests thrombus formation.E. Photomicrograph (hematoxylin-eosin stain; magnification ×100) depicts an AVM composed of abnormal vessels of various sizes and with fresh intraluminal thrombi (arrows).

Mentions: At initial presentation, a 41-year-old man complained of headache and blurred vision during exercise. The results of neurological examination were unremarkable, but contrast-enhanced CT scanning demonstrated a large intracerebral hematoma in the right occipital lobe accompanied by enlarged and tortuous vascular structures (Fig. 1A). At contrast enhanced T1-weighted MR imaging, in addition to the hematoma, a definite vascular structure representing an AVM was seen (Fig. 1B). Vertebral angiography revealed that this was supplied by the right posterior cerebral artery and drained into the right transverse sinus (Figs. 1C, D). Angiography of the internal carotid artery revealed no arterial feeder, and the external carotid was not angiographically examined at that time. The patient declined surgical treatment, including intravascular embolization. Four years later, although almost asymotomatic, he was admitted for treatment of the AVM. Follow-up contrast enhanced CT and cerebral angiography showed near-complete disappearance of the previous AVM, with normalization of its feeder, the right posterior cerebral artery (Figs. 2A, B). A residual AVM was revealed by right external carotid angiography (Figs. 2C, D); during the delayed phase of this, the draining vein seen during previous vertebral angiography was opacified. The lesion was removed surgically and confirmed as an AVM with multiple thrombotic foci (Fig. 2E).


Spontaneous partial regression of cerebral arteriovenous malformation.

Choi JH, Shin JH, Cho SS, Choi DL, Byun BJ, Kim DW - Korean J Radiol (2002 Jan-Mar)

Follow-up CT scan and angiogram four years later without further treatment.A. Enhanced CT scan reveals marked regression, with a small residual AVM in the right occipital lobe and some encephalomalatic change at the site of the previous hematoma.B. Right vertebral angiography shows complete disappearance of the AVM in the right occipital lobe.C. Early-phase angiogram of the right external carotid artery depicts a residual AVM supplied by the right middle meningeal artery (arrows).D. Late-phase angiogram of the right external carotid artery shows the same draining vein (arrow) seen at initial vertebral angiography, which drains into the right transverse sinus (arrowhead). The disappearance of the previous proximal portion of the draining vein seen in Fig. 1D suggests thrombus formation.E. Photomicrograph (hematoxylin-eosin stain; magnification ×100) depicts an AVM composed of abnormal vessels of various sizes and with fresh intraluminal thrombi (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713990&req=5

Figure 2: Follow-up CT scan and angiogram four years later without further treatment.A. Enhanced CT scan reveals marked regression, with a small residual AVM in the right occipital lobe and some encephalomalatic change at the site of the previous hematoma.B. Right vertebral angiography shows complete disappearance of the AVM in the right occipital lobe.C. Early-phase angiogram of the right external carotid artery depicts a residual AVM supplied by the right middle meningeal artery (arrows).D. Late-phase angiogram of the right external carotid artery shows the same draining vein (arrow) seen at initial vertebral angiography, which drains into the right transverse sinus (arrowhead). The disappearance of the previous proximal portion of the draining vein seen in Fig. 1D suggests thrombus formation.E. Photomicrograph (hematoxylin-eosin stain; magnification ×100) depicts an AVM composed of abnormal vessels of various sizes and with fresh intraluminal thrombi (arrows).
Mentions: At initial presentation, a 41-year-old man complained of headache and blurred vision during exercise. The results of neurological examination were unremarkable, but contrast-enhanced CT scanning demonstrated a large intracerebral hematoma in the right occipital lobe accompanied by enlarged and tortuous vascular structures (Fig. 1A). At contrast enhanced T1-weighted MR imaging, in addition to the hematoma, a definite vascular structure representing an AVM was seen (Fig. 1B). Vertebral angiography revealed that this was supplied by the right posterior cerebral artery and drained into the right transverse sinus (Figs. 1C, D). Angiography of the internal carotid artery revealed no arterial feeder, and the external carotid was not angiographically examined at that time. The patient declined surgical treatment, including intravascular embolization. Four years later, although almost asymotomatic, he was admitted for treatment of the AVM. Follow-up contrast enhanced CT and cerebral angiography showed near-complete disappearance of the previous AVM, with normalization of its feeder, the right posterior cerebral artery (Figs. 2A, B). A residual AVM was revealed by right external carotid angiography (Figs. 2C, D); during the delayed phase of this, the draining vein seen during previous vertebral angiography was opacified. The lesion was removed surgically and confirmed as an AVM with multiple thrombotic foci (Fig. 2E).

Bottom Line: Arteriovenous malformation (AVM) of the brain is one of the important pathologic conditions which cause intracerebral or subarachnoid hemorrhage, epilepsy, or chronic cerebral ischemia.The spontaneous regression of cerebral AVM is reported to be very rare and more likely to occur when the AVM is small, is accompanied by hemorrhage, and has fewer arterial feeders.We report a case of right occipital AVM which at follow-up angiography performed four years later showed near-complete spontaneous regression.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 657 Hannam-dong, Yongsan-gu, Seoul 140-743, Korea. jhshin@hosp.sch.ac.kr

ABSTRACT
Arteriovenous malformation (AVM) of the brain is one of the important pathologic conditions which cause intracerebral or subarachnoid hemorrhage, epilepsy, or chronic cerebral ischemia. The spontaneous regression of cerebral AVM is reported to be very rare and more likely to occur when the AVM is small, is accompanied by hemorrhage, and has fewer arterial feeders. We report a case of right occipital AVM which at follow-up angiography performed four years later showed near-complete spontaneous regression.

Show MeSH
Related in: MedlinePlus