Acta Neurochirurgica

, Volume 95, Issue 3–4, pp 102–108 | Cite as

“Nidus sparing sign” on computerized tomography in intracerebral haemorrhage due to a rupture of arteriovenous malformation

  • S. Wakai
  • M. Nagai
Clinical Articles

Summary

The authors investigated the validity of noncontrast computerized tomography (NCCT) to predict the presence of arteriovenous malformations (AVM) as a cause of intracerebral haemorrhage (ICH) in the acute stage. They found a small iso- or slightly hyperdense nodular or tubular defect devoid of haematoma in its periphery on NCCT in 8 of the 13 AVM cases that underwent both NCCT and contrast CT. This CT finding was named “nidus sparing sign” (NSS). This haematoma-free notch was enhanced on contrast infusion and confirmed to correspond to the AVM nidus surgically and pathologically. In one case with negative angiograms, a small AVM was verified histologically within the tissue corresponding to the NSS.

The NSS noted on the NCCT could be of great value in case emergency surgery is needed for comatose patients with ICH, particularly lobar ICH, without enough time left to undergo angiography and/or magnetic resonance imaging. Neurosurgeons are able to safely perform an evacuation of the haematoma keeping in mind the possibility of a ruptured AVM and if so, the spatial relationship between the AVM nidus and the haematoma. This might also be a valuable CT sign in deciding whether or not angiography should be undertaken in ICH cases.

Keywords

Nidus sparing sign lobar intracerebral haemorrhage arteriovenous malformation computerized tomography 
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bell BA, Kendall BE, Symon L (1978) Angiographically occult arteriovenous malformations of the brain. J Neurol Neurosurg Psychiatry 41: 1057–1064PubMedGoogle Scholar
  2. 2.
    Bradley WG, Waluch V, Yadley RA, Wycoff RR (1984) Comparison of CT and MR in 400 patients with suspected disease of the brain and cervical spinal cord. Radiology 152: 695–702PubMedGoogle Scholar
  3. 3.
    Brant-Zawadzki M, Davis PL, Crocks LE, Mills CM, Norman D, Newton TH, Sheldon P, Kaufmann L (1983) NMR demonstration of cerebral abnormalities: comparison with CT. AJR 140: 847–854PubMedGoogle Scholar
  4. 4.
    Brunelle FOS, Harwood-Nash DCF, Fritz CR, Chuang SH (1983) Intracranial vascular malformations in children: CT and angiographic evaluation. Radiology 149: 455–461PubMedGoogle Scholar
  5. 5.
    Butzer JF, Cancilla PA, Cornell SH (1976) Computerized axial tomography of intracerebral hematoma. A clinical and neuropathological study. Arch Neurol 33: 206–214PubMedGoogle Scholar
  6. 6.
    Chen MN, Nakazawa S, Ikeda Y, Murayama K (1985) CT findings of intracranial AVM. CT Kenkyu 7: 671–675 (Jpn)Google Scholar
  7. 7.
    Crowell RM, Ojemann RG (1981) Surgery for brain hemorrhage. In: Moossy J, Reinmuth OM (eds) Cerebrovascular diseases: twelfth research (Princeton) conference. Raven Press, New York, pp 233–254Google Scholar
  8. 8.
    Crowell RM (1985) Comments on Ref. 30. Neurosurgery 17: 556Google Scholar
  9. 9.
    DeLaPaz RL, New PFJ, Buouanno FS, Kistler JP, Oot RF, Rosen BR, Taveras JM, Brady TJ (1984) NMR imaging of intracranial hemorrhage. J Comput Assist Tomogr 8: 599–607PubMedGoogle Scholar
  10. 10.
    Fujita K, Shirakuni T, Masumura M, Matsumoto S (1986) MRI in arteriovenous malformation. CT Kenkyu 6: 653–659 (Jpn)Google Scholar
  11. 11.
    Gomori JM, Grossman RI, Goldberg HI, Zimmerman RA, Bilaniuk LT (1985) Intracranial hematomas: Imaging by high field MR. Radiology 157: 87–93PubMedGoogle Scholar
  12. 12.
    Gomori JM, Grossman RI, Goldberg HI, Hackery DB, Zimmerman RA, Bilaniuk LT (1986) Occult cerebral vascular malformations: high-field MR imaging. Radiology 158: 707–713PubMedGoogle Scholar
  13. 13.
    Hayman LA, Fox AJ, Evans RA (1981) Effectiveness of contrast regimens in CT detection of vascular malformations of the brain. AJNR 2: 421–425PubMedGoogle Scholar
  14. 14.
    Hayward RD, O'Reilly GVA (1976) Intracerebral haemorrhage. Accuracy of computerized transverse axial scanning in predicting the underlying aetiology. Lancet 1: 1–4PubMedGoogle Scholar
  15. 15.
    Hayward RD (1976) Intracranial arteriovenous malformations. Observations after experience with computerized tomography. J Neurol Neurosurg Psychiatry 39: 1027–1033PubMedGoogle Scholar
  16. 16.
    Kendall BE, Claveria LE (1976) The use of computerized axial tomography (CAT) for the diagnosis and management of intracranial angiomas. Neuroradiology 12: 141–160PubMedGoogle Scholar
  17. 17.
    Kramer RA, Wing SD (1977) Computed tomography of angiographically occult vascular malformations. Radiology 123: 649–652PubMedGoogle Scholar
  18. 18.
    Kucharczyk W, Lemme-Pleghos L, Uske A, Brant-Zawadzki M, Dooms G, Norman D (1985) Intracranial vascular malformations: MR and CT imaging. Radiology 156: 383–389PubMedGoogle Scholar
  19. 19.
    Kumar AJ, Fox AJ, Vinuela F, Rosenbaum AE (1984) Revisited old and new CT findings in unruptured larger arteriovenous malformations of the brain. J Comput Assist Tomogr 8: 648–655PubMedGoogle Scholar
  20. 20.
    Leblanc R, Ethier R, Little JR (1979) Computerized tomography findings in arteriovenous malformations of the brain. J Neurosurg 51: 765–772PubMedGoogle Scholar
  21. 21.
    Leblanc R, Levesque M, Comair Y, Ethier R (1987) Magnetic resonance imaging of cerebral arteriovenous malformations. Neurosurgery 21: 15–20PubMedGoogle Scholar
  22. 22.
    Lee BCP, Herzberg L, Zimmerman RD, Deck MDF (1985) MR imaging of cerebral vascular malformations. AJNR 6: 863–870PubMedGoogle Scholar
  23. 23.
    Lemme-Plaghos L, Kucharczyk W, Brant-Zawadzki M, Uske A, Edwards M, Norman D, Newton TH (1986) MRI of angiographically occult vascular malformations. AJR 146: 1223–1228PubMedGoogle Scholar
  24. 24.
    Masdeu JC, Rubino FA (1984) Management of lobar intracerebral hemorrhage: Medical or surgical. Neurology (Cleve) 34: 381–383Google Scholar
  25. 25.
    Nemoto Y, Inoue Y, Fukuda T, Shakudo M, Hashimoto H, Matsumura Y, Takemoto K, Kida A, Fukuda H, Onoyama Y, Hakuba A, Nishimura S (1987) MRI of cerebral vascular malformations. Jpn J Clin Radiol 32: 373–378 (Jpn)Google Scholar
  26. 26.
    New PFJ, Ojemann RG, Davis KR, Rosen BR, Heros R, Kjellberg RN, Adams RD, Richardson EP (1986) MRI and CT of occult vascular malformations of brain. AJNR 7: 771–779Google Scholar
  27. 27.
    Schorner W, Bradac GB, Treisch J, Bender A, Felix R (1986) Magnetic resonance imaging (MRI) in the diagnosis of cerebral arteriovenous angiomas. Neuroradiology 28: 313–318PubMedGoogle Scholar
  28. 28.
    Terao H, Hori T, Matsutani M, Okeda R (1979) Detection of cryptic vascular malformations by computerized tomography. Report of two cases. J Neurosurg 51: 546–551PubMedGoogle Scholar
  29. 29.
    Terbrugge K, Scotti G, Ethier R, Melancon D, Tchang S, Milner C (1977) Computed tomography in intracranial arteriovenous malformations. Radiology 122: 703–705PubMedGoogle Scholar
  30. 30.
    Wakai S, Ueda Y, Inoh S, Nagai M (1985) Angiographically occult angiomas: A report of thirteen cases with analysis of the cases documented in the literature. Neurosurgery 17: 549–556PubMedGoogle Scholar
  31. 31.
    Weisberg LA (1979) Computed tomography in the diagnosis of intracranial vascular malformations. Comput-Tomogr 3: 125–132PubMedGoogle Scholar
  32. 32.
    Young IR, Bydder GM, Hall AS, Steiner RE, Worthington BS, Hawkes RC, Holland GN, Moore WS (1983) NMR imaging in the diagnosis and management of intracranial angiomas. AJNR 4: 837–838PubMedGoogle Scholar
  33. 33.
    Zimmerman RA, Bilaniuk LT, Grossman RI, Levine RS, Lynchi R, Goldberg HI, Samuel L (1985) Resistive NMR of intracranial hematomas. Neuroradiology 27: 16–20PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • S. Wakai
    • 1
  • M. Nagai
    • 1
  1. 1.Department of NeurosurgeryDokkyo University School of MedicineTochigiJapan

Personalised recommendations