Summary
The results of a retrospective review of the clinical and radiological records of 63 patients with proven cerebral arteriovenous malformation are reported. Patients with dural arteriovenous malformations, and malformations with atypical angiographic features were excluded from the study. Of these 63 patients, 52 had a proven or suspected subrachnoid haemorrhage and 8 patients showed angiographic evidence of cerebral arterial spasm. Two of these patients had an associated intracranial aneurysm and were excluded from the study. The other 6 patients were shown to have spasm between two to thirteen days after a subarachnoid haemorrhage. The incidence of vasospasm associated with subarachnoid haemorrhage in this series was at most 12%. The probable explanation for the relative rarity of vasospasm associated with arteriovenous malformations of the brain, reported by other authors and confirmed by this study, is that the majority of these malformations are peripherally or deeply situated and subarachnoid bleeding is less likely to reach the base of the brain where arterial spasm mainly occurs as compared with haemorrhage from an aneurysm arising from the circle of Willis.
Résumé
Les auteurs présent les résultats d'un examen rétrospectif des notes cliniques et radiologiques de 63 patients avec des malformations cérébrales artérioveneineuses vérifiées. Les patients avec des malformations artérioveineuses de la dure-mère et des malformations avec des caractéristiques angiographiques atypiques ont été exclus de cet étude. De ces 63 patients, 52 avaient des hémorragies sous-arachnoidiennes vérifiées ou suspectes, et 8 patients ont manifesté des signes angiographiques évidents de spasme artériocérébral. Deux de ces patients avaient un anéurysme intracrânien et ont été donc exclus de cet étude. Les autres 6 patients avaient présenté des spasmes entre 2 et 13 jours après l'hémorragie sousarachnoidienne. Tous ces 6 patients ont montré un spasme de la partie terminale de la carotide interne. L'incidence de l'association du spasme et l'hémorragie sous-arachnoidienne dans cet étude n'était pas plus que 12%. La majorité des malformations artérioveineuses se situe à la périphérie ou au centre et il est moins probable que l'hémorragie sous-arachnoidienne atteigne la base du cerveau (où le spasme artériel se produit surtout) par comparaison à l'hémorragie d'un anéurysme du polygon de Willis. Ceci explique probablement la rareté relative du spasme associé aux malformations artérioveineuses cérébrales signalées par d'autres auteurs et confirmées par cet étude.
Zusammenfassung
In der vorliegenden Arbeit werden die klinischen und röntgenologischen Daten von 63 Patienten mit gesicherten arterio-venösen Gefäßmißbildungen des Gehirns beschrieben. Von diesen Kranken hatten 52 eine nachgewiesene Subarachnoidalblutung oder es bestand der hochgradige Verdacht auf eine Blutung. Bei insgesamt 8 Patienten lag ein cerebraler arterieller Gefäßspasmus vor. Bei 2 dieser Patienten bestanden Aneurysmen, sie wurden aus der Untersuchungsserie ausgeschieden. Bei den übrigen 6 konnte der Gefäßspasmus am 2. bis 13. Tag nach dem Auftreten der Subarachnoidalblutung beobachtet werden. Die Mehrzahl der arterio-venösen Mißbildungen lag in der Peripherie oder in der Tiefe des Gehirns. Dabei erreichte die Subarachnoidalblutung weniger leicht die basalen Hirnanteile, an denen gewöhnlich ein arterieller Spasmus auftritt.
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Nishimura, K., Hawkins, T.D. Cerebral vasospasm with subarachnoid haemorrhage from arteriovenous malformations of the brain. Neuroradiology 8, 201–207 (1975). https://doi.org/10.1007/BF00337652
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DOI: https://doi.org/10.1007/BF00337652