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Updated: Mar 31, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Intrapulmonary arteriovenous malformation causing recurrent strokes
Kareem Abed1, Lalith Premachandra2, Viren Vankawala2
1AtlantiCare Regional Medical Center, Atlantic City, NJ, USA; abedlkareem@gmail.com.
Abstract:
This case reveals a left pulmonary arteriovenous malformation (PAVM) as a cause of recurrent cerebral and cerebellar emboli. Extensive workup excluded other etiologies of emboli formation, and the patient was transferred to a tertiary care center for percutaneous embolotherapy. In the absence of a clear etiology, PAVM should be considered as a potential cause of recurrent cerebral emboli, especially in the absence of carotid disease, intracardiac thrombus, atrial septal defect, and patent foramen ovale. Diagnostic work-up for the PAVM can be cost effective and expedited by utilization of agitated saline contrast echocardiography, as noted in our case.
Insights
Pulmonary arteriovenous malformations (PAVMs) can cause recurrent brain emboli. Early diagnosis via echocardiography is key when other causes are ruled out.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Recurrent embolic events to the brain and cerebellum pose a diagnostic challenge.
- Pulmonary arteriovenous malformations (PAVMs) are uncommon vascular anomalies that can lead to paradoxical embolism.
Observation:
- A case is presented where a left PAVM was identified as the source of recurrent cerebral and cerebellar emboli.
- Standard workup for common embolic sources, including carotid disease and intracardiac shunts, was negative.
Findings:
- Percutaneous embolotherapy was successfully performed at a tertiary care center.
- Agitated saline contrast echocardiography proved to be a cost-effective and efficient diagnostic tool for PAVM detection.
Implications:
- PAVMs should be considered in the differential diagnosis of cryptogenic recurrent embolic strokes.
- Utilizing echocardiography can expedite the diagnosis of PAVMs, facilitating timely intervention and potentially preventing further neurological damage.
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