Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Vascula Lesion > AVM > Flashcards

AVM Flashcards

1
Q

What is AVM

A

Dysplastic blood vessels artery drain to vein w/o capillary, 🚫 brain 🧠 pranchyma in the nidus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Flow in AVM

A

Medium to high pressure
High flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

%%Risk of hemorrhage

A

1st time 1%/y
Recurrent 5%/y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risk factor for ⬆️ AVM rupture ⭐️

A

Female , Age
Deep venous drainage
Feeding artery anurysum
Small AVM
Previous hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

%risk of seizure

A

1st time unrupture AVM 8%
5-y risk of epilepsy and recurrent seizure 60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Source of AVM bleeding

A

Anurysum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SRS sterotactic surgery obligation rate

A

70-80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Indication of SRS

A

Deep lesion
< 3 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Embolization indication

A

High grade S-M
High flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Classification or type of AVM

A

1- parenchyma AVM. ( pial, subcortical,paraventricuLr,, combined)
2- dural AVM
3- mix prannchyma+dural AVM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MMC age of AVM

A

Young 30 vs 🔛 anurysum 40s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Syndrome asso w/ AVM ⭐️

A

Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia)

Klippel-Trénaunay-Weber syndrome,
Parkes Weber syndrome,
Sturge Weber syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MCC presentation AVM

A

Hemorrhage [ pure IVh 🔜 paraventriculrAVM , SAH
Smallest AVM bleed more than large ⏩️ high flow and pressure ) ,)
2nd seizure
Mass effect ,
Bruit if dural
HC in ped 🔜 VOM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The strongest prognosticator for future hemorrhage

A

Previous hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

RF seizure

A

Young
Temporal
Cortical
Idus > 3
Hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DX

A

CT to r/ o hemorrhage , calcification within the nidus
CTA high sensitivity and specificity
MRI ; T1, T2 GRE, SWi ( flow viod,feeding and draining hemosidrine)
🔘 edema ➡️ tumors , hemosidren ⭕️ SVM
MRA ➖ limited to detect small BV < 1 Mm , small nidus < 10 mm , anurysum
DSA ( tangle , draining and feeeding )

17
Q

Spetzler-Martin (S-M) grade of AV

A

Estimate risk of surgical resection
Requiring DSA or cross section image CT,MRI
Grade 6 untreatable
Mc grade present at stage III S-M

⭐️ Class A (S-M Grade I & II): surgical resection

● Class B (S-M Grade III): multimodality treatment

Class C (S-M Grade IV & V): f/ angiogram every 5 year if ➡️ new deficit ,steal sx,anurysum migh treat

18
Q

AVM mature at

A

At age 18 becom more compact

19
Q

Lawton-Young supplementary grading scale for AVMs

A

Better than S- M
Predict post operative surgical outcome using mRS
Use only inoperative AVM

20
Q

When can resection AVM after hemorrhage evacuation

A

2-6 week to allow ⬇️ edema and better AVM evaluation

21
Q

Mangment of rupture AVM

A

If low S- M with low L-Y , or high S- M with low L-Y
High S-M with fixed neurological deficit unlikely to affect after surgery

22
Q

Tx un rupture AVM according to ARUBA = medical > medical + intervention

A
23
Q

Surgical resection indication , cons , pron

A

Indication S-M 1 or 2
Cons eliminate risk of rebleeeidng and seizure controls
Cons invasive , cost 💲

24
Q

SE of SRS

A

Delay Se
Radarion necrosis🔘
🧠 edema , cystic formation
Pregnancy neurological changes

25
Q

SRS prons vs cons

A

Pron+ outpatient , non invasive , no recovery preriod , gradual reeducation , seizure control

  • latency period take 1-3 y to respond
    Risk of bleeding same during latency
26
Q

Endovascular AVM

A

Should done ✅ before 24-48 hr before resection
Pros +facilitate surgery if size
Cons- no permanent olitration , multiple procedures

27
Q

E,bolization prior SRS rate

A

W/ embolization 47%
W/o 70%

28
Q

Things had to take in consideration when tx AVM

A

associated aneurysms: on feeding vessels, draining veins, or intranidal

  1. flow: high or low
  2. age of patient
  3. history of previous hemorrhage
  4. size and compactness of nidus
  5. availability of interventional neuroradiologist
  6. general medical condition of the patient
29
Q

Surgical techniques

A

Wide exposure
Isolate and clip A then ▶️ vein
Working sulci and fissure

30
Q

Delay complication

A

NBPB normal pressure breakthrough ➡️ post op hemorrhage
Strok ➡️ occlusive hypermia
Rebleedin
Seizure

31
Q

Follow up 🔝

A

If complete ✅ resection ⏩️ post op DSA or MRI then ⏩️ 1 &5 y CTA or MRA
After SRS ☢️⏩️ a 6 m MRA, MRI oIF ❌🚫 CTA
If obliterate bu SRS ☢️ post op DSA ( latency period )

32
Q

📍 MCC location for AVM

A

parietal➡️ insula, frontal, and temporal lobe

33
Q

📍 apex of AVM

A

Preiventricular

34
Q

📍 AVM base

A

Cortex

35
Q

factors AVM ➡️ spontaneous occlusion

A

single draining vein

single feeding artery

Small nidus (<3 cm

36
Q

Factor increase ⬆️ AVM bleeding 🩸

A

Anatomical factor ; aneurysm , nidus( diffuse morphology ) , location ( deep preiventricular, intraventricualr, infratentorium) , impaired venous drainage ( deep venous drainage, venous stenosis, single draining vein, and venous reflux into a sinus or a deep vein), small size AVM

Hemodynamic➡️ high feeding artery pressure
Patient factor ➡️ increasing age, pediatric patients, pregnancy, HTN
Others residual nidus
S-M 4 -5

37
Q

Factor ⬇️ AVM bleeding

A

Arterial stenosis

  1. Arterial angioectasia
  2. Arterial border zone location of brain AVMs
  3. Venous recruitment
38
Q

Theory of seizure in AVM

A

Low CBF ➡️ ischmic insult brain
Gliosis around nidus might cause seizure

39
Q

ARUBA inclusion and exclusion criteria ⭐️

A

Inclusion Criteria:
Patient must have unruptured BAVM diagnosed by MRI/MRA, CTA and/or angiogram
Patient must be 18 years of age or older
Patient must have signed Informed Consent, Release of Medical Information, and Health Insurance Portability and Accountability Act (HIPAA/U.S. only) Forms
Exclusion Criteria:
Patient has BAVM presenting with evidence of recent or prior hemorrhage
Patient has received prior BAVM therapy (endovascular, surgical, radiotherapy)
Patient has BAVM deemed untreatable by local team, or has concomitant vascular or brain disease that interferes with/or contraindicates any interventional therapy type (stenosis/occlusion of neck artery, prior brain surgery/radiation for other reasons)
Patient has baseline Rankin ≥2
Patient has concomitant disease reducing life expectancy to less than 10 years
Patient has thrombocytopenia (< 100,000/μL),
Patient has uncorrectable coagulopathy (INR>1.5)
Patient is pregnant or lactating
Patient has known allergy against iodine contrast agents
Patient has multiple-foci BAVMs
Patient has any form of arteriovenous or spinal fistulas
Previous diagnosis of any of the following -
Patient has a diagnosed Vein of Galen type malformation
Patient has a diagnosed cavernous malformation
Patient has a diagnosed dural arteriovenous fistula
Patient has a diagnosed venous malformation
Patient has a diagnosed neurocutaneous syndrome such as cerebro-retinal angiomatosis (von Hippel-Lindau), encephalo-trigeminal syndrome (Sturge-Weber), or Wyburn-Mason syndrome
Patient has diagnosed BAVMs in context of moya-moya-type changes
Patient has diagnosed hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber)

Vascula Lesion (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions