Arteriography In Cerebral Arteriovenous Malformation

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THE term cerebral arteriovenous aneurysm or malformation is used to designate that type of cerebral vascular lesion in which the arterial and venous circulations are connected by a nest or cluster of racemose vessels.

Such lesions have been considered relatively uncommon. Cushing and Bailey1 in their analysis of 2023 proven brain tumors found fewer than 1 per cent, while Dandy2 quoted a similar figure. Ray,3 in 1941, reported 6 cases of his own and found approximately 75 in the literature. Five cases were reported by Hodes et al4 in 1947. However, in a series of 150 arteriograms made in a period of less than 2 years we have demonstrated 8 arteriovenous malformations. It therefore appears that this is a more common entity than was believed originally.

These malformations most often involve the middle cerebral artery and are considered congenital in origin. The arteries supplying the lesions are dilated and the associated veins are large, tortuous and pulsating. Calcium deposits in and adjacent to the vessels of the malformation are common; numerous thrombi may be present. It is these degenerative changes which predispose to subarachnoid hemorrhage and cortical damage.

The patient often presents a history of epileptic seizures, migraine type headaches, and permanent or transient paralysis of varying degree. The neurologic pattern is usually bizarre, and accompanied by such changes as cranial nerve paralysis, hemiparesis, vague sensory alterations, and visual field defects. On auscultation of the calvarium a bruit may be heard. The patient frequently is not aware of this. The. . .



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