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Vascular > Cerebrovascular malformations > Flashcards

Cerebrovascular malformations Flashcards

1
Q

What is AVM?

A

brain arteriovenous malformation

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2
Q

What is DAVF?

A

dural ateriovenous fistula.

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3
Q

What is PAVF?

A

pial arteriovenous fistula

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4
Q

What type of cerebrovascular malformation is “vein of Galen aneurysmal malformation”?

A

Its an AV-fistula.

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5
Q

HIgh or low flow?:
* AVM
* Cerebral proliferative angiopathy
* Dural AV-fistula
* vein of Galen aneurysmal malformation
* Pial arteriovenous fistula
* cavernous (venous) malformation
* capillary telangiectasia
* DVA-developmental venous anomaly
*cerebral venous varix
*sinus pericranii
*mixed vascular malformation

A

AVM -high flow
CPA - high flow
dAVF - high flow
! Vein of galen aneurysmal malformation - high flow
PIal AVF - high flow
Cavernous malformation - low flow
Capillary telangiectasia - low flow
DVA - low flow
Cerebral venous varix - low flow
Sinus pericranii - low flow
Mixed vascular malformation - low flow.

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6
Q

What cerebrovascular malformations has shunting?

A
  • AVM
  • cerebral proliferative angiopathy
  • AVF
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7
Q

What compose an AVM?

A

Enlarged feeding arteries
A nidus
Draining veins.

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8
Q

What is the difference between an AVM and a AV-fistula?

A

In an AV-fistula, there is no nidus forming the transition between the artery and the vein. Instead the transition is made directly.

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9
Q

HOw many % of brain AVMs are found before age 20yo?

A

1/3.

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10
Q

What is the thought etiology of AVM?

A

A congenital abnormality but that is thought to expand over time.

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11
Q

Are AVMs connected to any syndrome?

A

No, they are seen as solitary lesions and usually also are solitary, not multiple (98%)

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12
Q

Which are the three most common ways to find an AVM?

A
  1. hemorrhage 65%
  2. Seizures 20%
  3. incidental finding 15%
    BUt may also cause headache and ishemic events as it steal vascularity from normal brain.
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13
Q

This is difficult to understand.
Explain why feeding arteries of an AVM are enlarged.

A

Due to lack of resistance as it bypass the capillary bed.

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14
Q

Is the flow in a AVM high or low?

A

Its high, also due to low resistance. It may cause flow-related arterial aneurysms.

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15
Q

What is a typical finding in angiography of AVM?

A

*Early draining veins (dilated) during the arterial phase.
* Nidus in “a bag of worms”

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16
Q

What are the treatment options for AVM?

A
  • microsurgery
  • endovascular occlusion
  • radiosurgery
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17
Q

What can be used to deside on treatment option for AVM?

A

Spetzler-Martin grade.

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18
Q

What does the SPetzler-Martin grading system do?

A

It relates morphology and location of the AVM to risk of surgery

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19
Q

What three factors are graded on Spetzler-Martin scale?

A
  • size of nidus
  • Eloquence of adjacent brain
  • Venous drainage
20
Q

What is the minimum and maximum grade on Spetzler-Martin grading scale?

A

I-V.

21
Q

How are the sum calculated on SPetzler-Martin grading scale?

A

*Nidus size:
under 3cm = 1p
3-6cm = 2p
more than 6cm = 3p
*Eloquent adjacent brain:
no-0p
yes-1p
*Venous drainage:
Superficial veins only - 0p
Deep veins - 1p

22
Q

How is the size of the nidus defined?

A

As the largest diameter on an angiography.

23
Q

Name veins considered as deep

A

*Internal cerebral vein
*Basal vein of Rosenthal
*Precentral cerebellar vein

24
Q

Three aditional factors are weight to know if surgery is correlated to high risk. Which?

A

Age - under 20-1p, 20-40 -2p, over 40-3p.
Bleeding prior to surgery yes 0p or no 1p
Compact nidus or not?
yes 0p, no 1p.

Obs that already ruptured AVM is seen as less risky for surgery. lower the score the better.

25
Q

What is Dural AV-fistula, dAVF?

A

Heterogenous collection of conditions that all share an AV-shunt in dural vessels.

26
Q

How many % of cerebral vascular malformations are AV-fistulas?

A

10-15%

27
Q

Which are the two most common reasons for AV-fistuales?

A
  1. idiopatic
  2. Secondary to sinus thrombosis, usually transverse sinus.
28
Q

What is the most common location of AV-fistula?

A

Transverse/sigmoid sinus.

29
Q

There are two classficiation systems for AV-fistula. WHich?

A
  • Cognard classification
  • Borden classification.
30
Q

What is the single most important feature for prognosis of an AV-fistula?

A

The presence of retrograde leptomeningeal venous drainage.

31
Q

Is AV-fistula high or low-flow systems?

A

high.

32
Q

What are the 3 features of dural AV-fistula acording to Cognart?

A
  • Location
  • presence of cortical drainage
  • direction of flow
    *presence of venous ectasia
33
Q

Cognart type 1 AVF?

A
  • sinus
  • antergrade flow
  • no cortical venous drainage
34
Q

Cognart type 2 AVF?

A

II a-
* confined to sinus
* retrograde flow
* no cortical drainage

IIb-
**Drains into sinus and reflux into cortical veins.
*antegrade flow

IIa+b
** drains into sinus w reflux to cortical veins
* retrograde flow

III-
*Drains straight into cortical veins
Drainage w venous ectasia (65% hemorrhage)

IV-
Spinal perimedullary venous drainage - associated w progressive myelopathy

35
Q

What is different with AVF gade V accoring to Cognart?

A

It is only dealing with spinal AVF.

36
Q

What Cognart groups are seen as benign lesions?

A

Type I and IIa.

37
Q

Regarding Cognart group IIb and up, what is the annual non-hemorrhagic neurological deficit risk, the annual itracranial hemorrhage risk and the combined risk?

A
  • 6,9%
  • 8.1%
    *10.4%
38
Q
A
39
Q

What is DVA?

A

A congenital malformation of veins that drains normal brain.

40
Q

How common are DVAs?

A

The most common cerebral vascular malformation. Found incidentally on 2.5-9% of all contrast enhanced MRI scans.

41
Q

Which are the two most common locations of DVAs?

A

*Frontoparietal, draining towards frontal horm of lateral ventricle. about 50%
* Cerebellar hemisphere draining towards 4th ventricle - about 20%

42
Q

What is the pathogmomonic finding of DVAs?

A

Angiographic caput medusa head seen only in the venous phase. Arterial phase appears normal although late capillary blush may be seen. No shunting.

43
Q

What is the treatment of DVA?

A

no treatment unless associated with eg intracavernous mallformation that needs surgery. BUT WATCH OUT then. The DVA extraction might cause venous infarction of the area it was draining.

44
Q

What is the yearly complication rate of a DVA?

A

0.15% - from spontaneous thrombosis and venous infarction and hemorrhage.

45
Q
A

Vascular (10 decks)

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