vascular malformations Flashcards
When do most AVM present?
middle age, 65% >40 yo
What are the main symptoms of AVM? Who is at most risk of rupture?
Hemorrhage, seizure, headache
Pregnant
Where are most AVM located?
80% are supratentorial
What factors increase risk of bleed in AVM?
deep or periventricular location, intranidal aneurysm, venous aneurysm, deep venous drainage
What syndromes have multiple AVM?
Osler-weber-rendau, Wyburn mason, craniofacial AV metameric syndrome
What is the appearnce of AVM after stereotactic radiosurgery?
Cystic
What is a cavernous malformation?
Slow flow low pressure malfomation with no normal intervening brain parenchyma
Where are most cavernous malformations?
80% supratentorial
What is the most common intracranial vascular malformation? second?
DVA > Cavernous malformation
What is the most common symptom of cavernous malformation? What is transitional type cavernous malformation?
50% have seizures
Associated venous malformation
What is the appearance of cavernous malformation?
Mulberry/popcorn appearance on noncon T1, can have T1 hyperintense rim
What location do dva bleed? What is the association with bleeding dva?
Posterior fossa
Cavernoma
What is a dva?
extreme form of normal variant; drainage of normal brain and composed of dilated medullary veins that converge into a large channel that drains into cortical or subependymal veins
Where do most dva occur? What syndrome has multiple?
Supratentorial, frontal lobes
Blue rubber-bleb syndrome
Where are capillary telangectasias most common?
What are they?
What is the cause?
Pons
Capillaries surrounded by normal brain
whole brain irradiation
What is the imaging of capillary telangectasia?
Enhance
Low signal on GRE
Nonspecific on T1
Can be mildly hyperintense on T2/FLAIR
What is the cause of dural AV fistula? Where do they commonly occur?
What is the supply?
Occlusion of venous sinus - will result in angiogenesis
Cavernous sinus, posterior fossa, tentorium
Branches of ECA
What is a sign of emergent treatment in dural AV fistula?
Cortical vein reflux
What are the two types of carotid artery-cavernous sinus fistula?
Direct (high flow): direct communication between intracavernous ICA and cavernous sinus, young males, drain into superior ophthalmic vein and inferior petrosal sinus
Indirect (low flow): Less common, middle age females
What are the symptoms in direct CA-CS fistula? indirect?
Direct: pulsatile exophthalmos, bruit, conjunctival chemosis, CN palsies
Indirect: proptosis, conjunctival chemosis, bruit
What is the imaging of carotid artery-cavernous sinus fistula?
Enlarged and dilated superior ophthalmic vein and inferior petrosal sinuses
What are the types of vein of galen malformation?
1 - fistula; choroidal, multiple feeders, neonates with CHF and hydrocephalus
Mural; few feeders from collicular or posterior choroidal arteries
2 - AVM in midbrain or thalamus with drainage into vein of galen, infancy with developmental delay, bruit
3 - combo of AVM and av fistula
Pseudomalformation - secondary dilation of vein of galen due to distal AVM drainage
What is the difference between type I choroidal and mural vein of galem malformation?
Choroidal - many feeders, neonates with CHF and hydrocephalus
Mural - few feeders
