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Cerebral arteriovenous malformations and movement disorders
J K Krauss1, G D Kiriyanthan, J J Borremans
1Department of Neurosurgery, Inselspital, University of Berne, Switzerland. jkrauss@insel.ch
Abstract:
A series of six patients with movement disorders associated with cerebral arteriovenous malformations (AVM) is reported. The AVMs were classified according to the Spetzler-Martin classification as grade V (one patient), grade IV (four patients), and as grade III (one patient). One patient had action-induced hemidystonia caused by a contralateral frontoparietal AVM which compressed the putamen and was supplied partially by enlarged lenticulostriate arteries. Two patients presented with unilateral cortical tremor associated with contralateral high-frontal cortical/subcortical AVMs sparing the basal ganglia. Another patient developed hemidystonia and hemichorea-hemiballism after bleeding of a contralateral temporooccipital AVM and subsequent ischemia. Two patients had focal dystonia after thalamic and basal ganglia hemorrhage from AVMs. Five patients were operated on. The movement disorder was abolished in one patient postoperatively. Different mechanisms were identified that are relevant for the development of AVM-related movement disorders: mass effect, diaschisis, local parenchymal altered cerebral blood flow, and hemorrhagic or ischemic structural lesions.
Insights
Cerebral arteriovenous malformations (AVMs) can cause movement disorders through various mechanisms like compression and bleeding. Surgical intervention may resolve these neurological symptoms in some cases.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Cerebral arteriovenous malformations (AVMs) are complex vascular lesions that can present with diverse neurological deficits.
- Movement disorders are an uncommon but recognized manifestation of cerebral AVMs.
Observation:
- This report details six patients experiencing movement disorders linked to cerebral AVMs.
- AVMs were graded using the Spetzler-Martin classification, with most being high-grade (IV-V).
- Observed movement disorders included hemidystonia, cortical tremor, hemichorea-hemiballism, and focal dystonia.
Findings:
- Mechanisms contributing to AVM-related movement disorders include mass effect, diaschisis, altered cerebral blood flow, and hemorrhagic or ischemic lesions.
- One patient with hemidystonia experienced symptom resolution after surgery.
- Contralateral AVMs affecting basal ganglia, putamen, or cortical/subcortical regions were implicated.
Implications:
- Understanding the diverse mechanisms underlying AVM-related movement disorders is crucial for diagnosis and management.
- Surgical intervention may offer a potential treatment for select patients.
- Further research is warranted to elucidate the precise pathophysiology and optimize therapeutic strategies.