vascular malformations

Question 1

When do most AVM present?

Answer 1

middle age, 65% >40 yo

Question 2

What are the main symptoms of AVM? Who is at most risk of rupture?

Answer 2

Hemorrhage, seizure, headache

Pregnant

Question 3

Where are most AVM located?

Answer 3

80% are supratentorial

Question 4

What factors increase risk of bleed in AVM?

Answer 4

deep or periventricular location, intranidal aneurysm, venous aneurysm, deep venous drainage

Question 5

What syndromes have multiple AVM?

Answer 5

Osler-weber-rendau, Wyburn mason, craniofacial AV metameric syndrome

Question 6

What is the appearnce of AVM after stereotactic radiosurgery?

Answer 6

Cystic

Question 7

What is a cavernous malformation?

Answer 7

Slow flow low pressure malfomation with no normal intervening brain parenchyma

Question 8

Where are most cavernous malformations?

Answer 8

80% supratentorial

Question 9

What is the most common intracranial vascular malformation? second?

Answer 9

DVA > Cavernous malformation

Question 10

What is the most common symptom of cavernous malformation? What is transitional type cavernous malformation?

Answer 10

50% have seizures

Associated venous malformation

Question 11

What is the appearance of cavernous malformation?

Answer 11

Mulberry/popcorn appearance on noncon T1, can have T1 hyperintense rim

Question 12

What location do dva bleed? What is the association with bleeding dva?

Answer 12

Posterior fossa

Cavernoma

Question 13

What is a dva?

Answer 13

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

Question 14

Where do most dva occur? What syndrome has multiple?

Answer 14

Supratentorial, frontal lobes

Blue rubber-bleb syndrome

Question 15

Where are capillary telangectasias most common?

What are they?

What is the cause?

Answer 15

Pons

Capillaries surrounded by normal brain

whole brain irradiation

Question 16

What is the imaging of capillary telangectasia?

Answer 16

Enhance
Low signal on GRE
Nonspecific on T1
Can be mildly hyperintense on T2/FLAIR

Question 17

What is the cause of dural AV fistula? Where do they commonly occur?

What is the supply?

Answer 17

Occlusion of venous sinus - will result in angiogenesis

Cavernous sinus, posterior fossa, tentorium

Branches of ECA

Question 18

What is a sign of emergent treatment in dural AV fistula?

Answer 18

Cortical vein reflux

Question 19

What are the two types of carotid artery-cavernous sinus fistula?

Answer 19

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

Question 20

What are the symptoms in direct CA-CS fistula? indirect?

Answer 20

Direct: pulsatile exophthalmos, bruit, conjunctival chemosis, CN palsies

Indirect: proptosis, conjunctival chemosis, bruit

Question 21

What is the imaging of carotid artery-cavernous sinus fistula?

Answer 21

Enlarged and dilated superior ophthalmic vein and inferior petrosal sinuses

Question 22

What are the types of vein of galen malformation?

Answer 22

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

Question 23

What is the difference between type I choroidal and mural vein of galem malformation?

Answer 23

Choroidal - many feeders, neonates with CHF and hydrocephalus

Mural - few feeders