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Pial arteriovenous malformation with massive perinidal edema
S Shimizu1, Y Miyasaka, R Tanaka
1Department of Neurosurgery, Kitasato University, School of Medicine, Sagamihara, Kanagawa, Japan.
Abstract:
It is generally considered that perinidal edema in an arteriovenous malformation (AVM) is caused by a concomitant intracerebral hematoma. We report a rare case of AVM with perinidal massive edema which was possibly not due to hemorrhage, and discuss the pathophysiological mechanisms of such edema development. A 60-year-old woman presented with a sudden onset severe headache. Computed tomography (CT) scans obtained two hours after the onset showed an AVM-like lesion with a small hematoma in the right parieto-occipital lobe, and unexpectedly early development of massive edema adjacent to the hematoma. Angiograms demonstrated a medium-sized AVM, and severe stenosis in the draining vein which suggested the presence of venous hypertension at prestenotic sites. Repeated CT scans and magnetic resonance (MR) images in the chronic period after the hemorrhage demonstrated persistence of the perinidal edema with mass effect. Removal of the lesion was achieved 2 months after the onset. MR images 3 months after the operation showed marked reduction of perinidal edema. The time course of the perinidal edema suggests that its development was unrelated to the hemorrhage. The findings indicate that increased venous pressure secondary to severe stenosis of the draining vein may possibly contribute to the development of perinidal edema.
Insights
This study presents a rare case of arteriovenous malformation (AVM) with massive perinidal edema, suggesting venous hypertension, not hemorrhage, as a potential cause. This finding challenges conventional understanding of AVM-related edema.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Perinidal edema in arteriovenous malformations (AVMs) is typically attributed to concurrent intracerebral hematomas.
- Understanding the mechanisms of AVM-related edema is crucial for effective patient management.
Observation:
- A 60-year-old woman presented with sudden severe headache and an AVM with a small hematoma and massive adjacent edema.
- Angiography revealed severe stenosis in the draining vein, indicating prestenotic venous hypertension.
- Edema persisted post-hemorrhage and significantly reduced after AVM removal.
Findings:
- The temporal course of edema suggested it was independent of the hemorrhage.
- Severe stenosis in the draining vein and resulting venous hypertension are implicated as potential causes of perinidal edema.
- This case highlights a rare presentation of AVM with massive edema possibly driven by venous pressure.
Implications:
- The findings suggest venous hypertension secondary to draining vein stenosis may be a significant factor in perinidal edema development.
- This challenges the established view that hemorrhage is the sole cause of such edema.
- Further research into venous hemodynamics in AVMs is warranted to refine diagnostic and therapeutic strategies.