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Ismail M, Al-Ageely TA, Talib SH, Hadi RT, Al-Taie RH, Aktham AA, Alrawi MA, Salih HR, Al-Jehani H, Hoz SS. Atypical slow-flow paramedian AVM with venous varix. Surg Neurol Int 2022; 13:519. [DOI: 10.25259/sni_920_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background:
Cerebral arteriovenous malformations (CAVMs) are either clinically silent or symptomatic. The most common presentation in more than half of all CAVMs presenting patients is hemorrhage which is accompanied by long-standing neurological morbidity and mortality. This report presents a case of an atypical large, slow-flow paramedian AVM with a dilated venous varix managed with surgery. The impact of the intraoperative findings on the diagnosis and the operative technique will be discussed.
Case Description:
In otherwise, healthy 26-year-old male complained of repeated episodes of generalized seizures and loss of consciousness. Brain magnetic resonance imaging (MRI) revealed a right parietal paramedian arteriovenous malformation (AVM) with signs of an old hemorrhagic cavity beneath it. Digital subtraction angiography demonstrated a slow-filling AVM with dilated venous varix drains into the superior sagittal sinus. However, the exact point of drainage cannot be appreciated. The filling of the AVM occurred precisely with the beginning of the venous phase. Intraoperatively, we noticed a whitish spherical mass, thick hemosiderin tissue, and a large cavity below the nidus; then, a complication-free complete microsurgical resection of this high-grade AVM was performed. Postoperatively, the patient suffered two attacks of seizures in the first few hours after the surgery, for which he received antiepileptics. MRI was clear during follow-up, and the patient was seizure-free and neurologically intact.
Conclusion:
Parietal convexity AVMs are challenging lesions to tackle. However, the chronicity and the slow-filling of the AVM, in this case, can render the surgical pathway more direct and accessible.
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Affiliation(s)
- Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Teeba A. Al-Ageely
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Sura H. Talib
- Department of Neurosurgery, University of Al-Mustansiriyah, College of Medicine, Baghdad, Iraq,
| | - Rania Thamir Hadi
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Rania H. Al-Taie
- Department of Neurosurgery, University of Al-Mustansiriyah, College of Medicine, Baghdad, Iraq,
| | - Awfa A. Aktham
- Department of Neurosurgery, Tokyo General Hospital, Nakano, Japan,
| | - Mohammed A. Alrawi
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq,
| | - Hayder R. Salih
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq,
| | - Hosam Al-Jehani
- Department of Neurosurgery, Imam Abdulrahman Alfaisal University, Dammam, Saudi Arabia,
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
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Haettel P, Devalckeneer A, Bretzner M, Bourgeois P, Lejeune JP, Reyns N, Aboukais R. Cerebral arterio-venous malformations hemodynamics changes in hereditary hemorrhagic telangiectasia – case report. Neurochirurgie 2022; 68:e101-e103. [DOI: 10.1016/j.neuchi.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022]
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Hu MB, Kesha K, Glenn C, Stables S, Tse R. Hemorrhagic Pseudocyst: A Rare Cerebral Mass Lesion Causing Death. A Case Report and Brief Review of Literature. Am J Forensic Med Pathol 2021; 42:77-80. [PMID: 33555675 DOI: 10.1097/paf.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Mass lesions in the brain encompass a wide range neoplastic and nonneoplastic entities. These can present as a diagnostic pitfall, with nonspecific, overlapping symptoms and similar appearances on radiology. They may cause death through varied mechanisms, either specific to the underlying pathophysiology or due to the space-occupying effect of the lesion. We report a case of fatal hemorrhagic cerebral pseudocyst, a rare mass lesion, associated with a cerebral varix, causing death in a morbidly obese individual. To the best of our knowledge, there is no previous documentation in the postmortem literature of this entity as a cause of death. This case aims to document this rare entity in the differential diagnosis of a tumor-like lesion in the brain, highlight the clinical difficulty in its assessment, and demonstrate an uncommon mechanism of death, of a mass lesion acting as a focus causing seizures, with resulting hypoxia due to effects of morbid obesity and heart failure.
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Affiliation(s)
- Mindy Bizhe Hu
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
| | - Kilak Kesha
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
| | - Charley Glenn
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
| | - Simon Stables
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
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