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Neurology (Expert Forum)
ct angiography brain, want to know whats going on and whats needed to be done.
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ct angiography brain, want to know whats going on and whats needed to be done.
by pola, Apr 18, 2007 12:00AM
Abnormal dilatedvascularchannels are noted in left occipital lobe posterior to the area of resolvinghaemorrahage. these are best delineated in the venous phase. In the arterial phase a small communication is noted from the right posteriorcerebral artery feeding these vessels.Superiorly these vascular channels are draining in to the superior sagital sinus and abnormal vascular channels along the left side of upper part of falx cerebri.
An extra dural hygroma is seen along the inner surfaceof right frontal and parietal bones.
Ct angiography of the rest of the cerebral vessel is normal.
good flow of cotrast medium is noted in all the vessels.
no persistent filling deffect or narrowing is observed.
the circle of villus is normal in out line.
A burr whole is seen in right parietal bone.
MPRESSION 1. AV MALFORMATION RIGHT PARIETO OCCIPAL REGION
2. RESOLVING HEMMORHAGE RIGHT PARIETAL LOBE
3.EXTRA DURAL HYGROMA
My brother 44 years old had stroke neuro surgeon sucked out the blood that drained, while recovering excellently this has been found through angiography. met few neuro surgeons all have different opinions,what would you suggest and please describe this abnormality in simple words so i can have an idea whats going on. Thanks
An extra dural hygroma is seen along the inner surfaceof right frontal and parietal bones.
Ct angiography of the rest of the cerebral vessel is normal.
good flow of cotrast medium is noted in all the vessels.
no persistent filling deffect or narrowing is observed.
the circle of villus is normal in out line.
A burr whole is seen in right parietal bone.
MPRESSION 1. AV MALFORMATION RIGHT PARIETO OCCIPAL REGION
2. RESOLVING HEMMORHAGE RIGHT PARIETAL LOBE
3.EXTRA DURAL HYGROMA
My brother 44 years old had stroke neuro surgeon sucked out the blood that drained, while recovering excellently this has been found through angiography. met few neuro surgeons all have different opinions,what would you suggest and please describe this abnormality in simple words so i can have an idea whats going on. Thanks
Doctor's Answer
by Forum-M.D.-SH, May 07, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The problem that is described here is called a aterio-venous malformation (AV malformation, or AVM) , these are problems that people are born with and later in life they can bleed (causing a stroke) and/or can cause seizures. These lesions consist of arteries (blood vessels carrying blood away from the heart) and veins (blood vessels carrying blood to the heart) that are directly connected in an abnormal web of blood vessels. Normal blood vessels start at the heart as arteries and then become smaller arteries, then deliver the blood to your organs/muscles etc by capillaries (which are tiny hair like blood vessels). After the blood exits the capillaries it collects into veins that turn into larger veins and eventually reconnect to the heart. Arteries are under high pressure to deliver nutrients to the tissues, while viens are under low pressure. If they are directly connected (without any capillary network) this creates very fast and turbulent blood flow from the arteries into the veins. Along with the fast flow, the vessels are abnormal and tangled and often result in small bleeds over the years that go unnoticed, until a big bleed happens. These AVMs often have normal brain tissue that is caught up inbetween the web of abnormal blood vessels, making surgery difficult. There are different surgical approaches that can be taken to treat this AVM. One is surgical resection, another is selective embolization that is often combined with surgical resection. When AVMs are not causing problems (as in the previous 43 years of your brothers life) they can be observed and followed with imaging. However, when they are symptomatic (causing bleeds, stroke, seizures etc) then an intervention should be attempted to prevent further damage. I would suggest that you see a neurosurgeon at a major academic center for further treatment options.
I hope this has been helpful.
The problem that is described here is called a aterio-venous malformation (AV malformation, or AVM) , these are problems that people are born with and later in life they can bleed (causing a stroke) and/or can cause seizures. These lesions consist of arteries (blood vessels carrying blood away from the heart) and veins (blood vessels carrying blood to the heart) that are directly connected in an abnormal web of blood vessels. Normal blood vessels start at the heart as arteries and then become smaller arteries, then deliver the blood to your organs/muscles etc by capillaries (which are tiny hair like blood vessels). After the blood exits the capillaries it collects into veins that turn into larger veins and eventually reconnect to the heart. Arteries are under high pressure to deliver nutrients to the tissues, while viens are under low pressure. If they are directly connected (without any capillary network) this creates very fast and turbulent blood flow from the arteries into the veins. Along with the fast flow, the vessels are abnormal and tangled and often result in small bleeds over the years that go unnoticed, until a big bleed happens. These AVMs often have normal brain tissue that is caught up inbetween the web of abnormal blood vessels, making surgery difficult. There are different surgical approaches that can be taken to treat this AVM. One is surgical resection, another is selective embolization that is often combined with surgical resection. When AVMs are not causing problems (as in the previous 43 years of your brothers life) they can be observed and followed with imaging. However, when they are symptomatic (causing bleeds, stroke, seizures etc) then an intervention should be attempted to prevent further damage. I would suggest that you see a neurosurgeon at a major academic center for further treatment options.
I hope this has been helpful.
Member Comments (3)
by vega1318, Apr 21, 2007 12:00AM
Sorry to hear about your brother. AV malformation or arterio-venous malformation is a congenital abnormality in blood vessels which simply means that your arteries and veins are not separated the way they should be and form a "knot" or a "tangle" of blood vessels - these can be small or large. Since your arteries are under higher blood pressure than your veins - if you mix them together, the "Knot" can have different pressures within it and can burst spontaneously - leading to a hemorrhage. Some AV malformations never bleed and some bleed profusely. Once an AVM bled, it is probably best to try and treat it but it can be tricky as part of it may supply blood and oxygen to very vital parts of the brain (i.e., speech, arm and length strength, etc.) and cutting it out or closing it may lead to further damage or stroke. YOu need to consult with a team of Interventional neuroradiologists, Neurosurgeons and Neurologists who will advise you the risks and benefits of proceeding with treatment.
by jcverive, May 07, 2007 12:00AM
To: pola
As for the burr hole, it seems a surgeon opened the skull through a small hole in order to gain access to an area in which blood was accumulating. This is especially necessary in the ER where something has to be done immediately in oder to prevent active internal bleeding from increasing the pressure on the brain. If you were unaware of such a procedure having been performed, you ought to find out when and where it was done, and by whom. This information may prove useful in the future should a problem arise due to the procedure, and at the very least it will help you understand the MRI results.