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de Souza Coelho D, Fernandes de Oliveira Santos B, Silva da Costa MD, Silva GS, Cavalheiro S, Santos FH, Chaddad-Neto F. Cognitive performance in patients with cerebral arteriovenous malformation. J Neurosurg 2020; 132:1548-1555. [PMID: 31465157 DOI: 10.3171/2018.12.jns181883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/31/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A cerebral arteriovenous malformation (cAVM) can change over time and cause symptoms, but clinical studies tend to define only the patients with ruptured cAVMs as symptomatic and do not consider neurocognitive aspects prior to neurosurgical intervention. The objective of this study was to describe the neurocognitive function of patients with ruptured and unruptured cAVMs according to the Spetzler-Martin (SM) grade, flow status, and anatomical topography. METHODS In this blinded cross-sectional study, 70 patients of both sexes and ages 18-60 years were evaluated using the Brazilian Brief Neuropsychological Assessment Battery Neupsilin. RESULTS Of the 70 patients with cAVMs, 50 (71.4%) demonstrated deficits in at least one of the eight neurocognitive domains surveyed, although they did not exhibit neurological deficits. cAVMs in the temporal lobe were associated with memory deficits compared with the general population. The SM grade was not significantly associated with the results of patients with unruptured cAVMs. However, among patients with ruptured cAVMs, there were deficits in working memory in those with high-grade (SM grade) cAVMs and deficits in executive function (verbal fluency) in those with low-grade cAVMs (p < 0.001). CONCLUSIONS This study indicates that patients with untreated cAVMs, either ruptured or unruptured, already exhibit neurocognitive deficits, even the patients without other neurological symptoms. However, the scales used to evaluate disability in the main clinical studies, such as A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA), do not assess neurocognitive alterations and therefore disregard any deficits that may affect quality of life. The authors' finding raises an important question about the effects of interventional treatment because it reinforces the hypothesis that cognitive alterations may be preexisting and not determined by interventions.
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Affiliation(s)
- Daniela de Souza Coelho
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | | | | | - Gisele Sampaio Silva
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | - Sergio Cavalheiro
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | | | - Feres Chaddad-Neto
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
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2
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LoPresti MA, Giridharan N, Pyarali M, Gadgil N, Kan PT, Niedwiekci C, Lam SK. Pediatric intracranial arteriovenous malformations: Examining rehabilitation outcomes. J Pediatr Rehabil Med 2020; 13:7-15. [PMID: 32176668 DOI: 10.3233/prm-190609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Arteriovenous malformation (AVM) rupture in children can cause debilitating neurological injury. Rehabilitation is key to recovery, though literature details little regarding rehabilitation outcomes. We examined a single-center experience with pediatric AVMs as related to acute inpatient rehabilitation outcomes. METHODS At our institution, a retrospective chart review was completed examining all cases of intracranial AVMs in patients age 18 and younger who completed our acute inpatient rehabilitation program between 2012-2018. Patient characteristics, clinical data, treatment modality, and functional outcomes were reviewed. RESULTS 14 patients with AVMs underwent acute inpatient rehabilitation; nine (64.3%) treated surgically at our institution, two (14.3%) non-surgically at our institution, and three (21.4%) surgically at an outside facility prior to transitioning care at our institution. Eight (57.1%) were male, seven (50.0%) Caucasian, and seven (50.0%) Hispanic. Seven (50.0%) presented with AVM rupture; six (42.9%) were found incidentally on imaging. Clinical courses, treatment outcomes, and post-treatment complications varied. Several patients underwent repeat treatment or additional procedures. Neurological deficits identified included hemiparesis, dystonia, spasticity, epilepsy, hydrocephalus, and ataxia. Inpatient rehabilitation unit length of stay was on average 21 days (SD 9.02, range 9-41). Functional Independence Measure for Children (WeeFIM®) scores, including self-care, mobility, and cognition, demonstrated improvement upon discharge. The mean total change was 36.7 points in those treated surgically, 16.5 in those treated non-surgically, and 25.7 in those treated surgically at another facility. CONCLUSION We found that all pediatric patients with intracranial AVMs, across all treatment modalities, demonstrated improved outcomes across all functional domains after an acute inpatient rehabilitation program.
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Affiliation(s)
- Melissa A LoPresti
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nisha Giridharan
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Monika Pyarali
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nisha Gadgil
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Peter T Kan
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Christian Niedwiekci
- Department of Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, TX, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Lurie Children's Hospital, Department of Neurosurgery, Northwestern University, Chicago, IL, USA
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Fabri TL, Stewart ML, Stevens SA. Informing pediatric rehabilitation: Language-based neuropsychological profile following traumatic brain injury and stroke secondary to arteriovenous malformation. J Pediatr Rehabil Med 2018; 11:15-21. [PMID: 29630561 DOI: 10.3233/prm-160429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe language-based neuropsychological outcomes following brain injury in two pediatric populations commonly treated in rehabilitation settings, namely severe traumatic brain injury (sTBI) and stroke secondary to arteriovenous malformation (AVM). METHODS Investigated were children between the ages of 6 and 16 who were admitted to a brain injury rehabilitation program in a pediatric rehabilitation hospital and who were diagnosed with a left-sided sTBI (n= 16; mean age = 13.2) or a left-hemispheric stroke secondary to AVM (n= 16, mean age = 10.7). Groups were compared on demographic information, as well as general cognitive and language-based neuropsychological measures, controlling for age. RESULTS Children in the AVM group presented with greater deficits, at trend levels, relative to the sTBI group on measures of working memory, verbal fluency, and an aphasia screening tool. CONCLUSIONS This study represents an initial step in understanding the language-based neuropsychological outcomes of children diagnosed with sTBI compared to those with stroke secondary to AVM, which will help inform the rehabilitation process. With this knowledge, clinicians, families, and educators will be better equipped to provide informed individual rehabilitation programs, recommendations, and education for children and adolescents with brain injuries.
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Affiliation(s)
- Tracy L Fabri
- Brain Injury Rehabilitation Team, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Mary L Stewart
- Brain Injury Rehabilitation Team, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Sara A Stevens
- Brain Injury Rehabilitation Team, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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4
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Stein KP, Huetter BO, Goericke S, Oezkan N, Leyrer R, Sandalcioglu IE, Forsting M, Sure U, Mueller O. Cerebral arterio-venous malformations in the paediatric population: Angiographic characteristics, multimodal treatment strategies and outcome. Clin Neurol Neurosurg 2017; 164:164-168. [PMID: 29245106 DOI: 10.1016/j.clineuro.2017.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 11/04/2017] [Accepted: 12/03/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Cerebral arterio-venous malformations (AVM) are considered congenital lesions, emerging as an important cause of haemorrhagic stroke in children. The potential influence of age on clinical presentation and angio-architecture have been analysed extensively in the last years. Yet, comparative studies comprising ascending age groups may be limited in their conclusions, especially when comparing young children and adults. It is the aim of this study to evaluate characteristic clinical and angiographic features of AVM within a paediatric subgroup and their correlation to age at presentation. PATIENTS AND METHODS Between 1990-2015, 46 children harbouring AVMs were treated at our institution. Clinical presentation, radiological data, treatment strategies and outcome were evaluated retrospectively. RESULTS Of 46 consecutive patients, 18 were male and 28 female patients. Mean age was 11.6±4.3years, ranging from 2 to 17 years. 35 patients (76%) presented with haemorrhage. Seizures were found in 6 patients (13%) and progressive or transient focal neurological deficits in 4 individuals (9%). There was one incidental patient, only. Mean age of children presenting with haemorrhage was significantly lower as compared to those without a history of intracranial bleeding (p=0.1). The size of the AVM was small (n=27, 59%), corresponding a grade I AVM in the majority of patients (N=28, 61%). 41 patients (89%) underwent treatment of their AVM by an interdisciplinary approach achieving complete elimination of the lesion in 34 patients (83%). 34 patients (83%) showed at least a favourable outcome (mRS≤2) at last follow-up. An excellent recovery (mRS 0-1) was noted in 28 patients (68%). CONCLUSION From our data we suggest that patients' age impacts the clinical presentation. Particularly young children seem to bear a higher risk for haemorrhage from their AVM. Treatment of paediatric AVMs can be achieved safely in experienced hands with a high rate of complete elimination and good clinical outcome.
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Affiliation(s)
- Klaus-Peter Stein
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany; Department of Neurosurgery, KRH Hospital Nordstadt, Haltenhoffstr.41, 30167 Hannover, Germany.
| | - Bernd-Otto Huetter
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Sophia Goericke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Neriman Oezkan
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Rebecca Leyrer
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, KRH Hospital Nordstadt, Haltenhoffstr.41, 30167 Hannover, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Oliver Mueller
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
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Sison V, Stackhouse T, Breeze R, Hall T, McKenzie P, Tartaglia N. Arteriovenous Malformation in a Youth with Atypical Autism Symptoms. ACTA ACUST UNITED AC 2017; 3. [PMID: 28989994 DOI: 10.4172/2472-1786.100042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cerebral arteriovenous malformations (AVMs) present a challenge to diagnose in children with developmental disability, because of the overlap in behavioral symptoms and neurologic manifestations. They have been very rarely reported in conjunction with autism spectrum disorder. This case involves a 13 year old male with a history of autism spectrum disorder and significant behavioral issues diagnosed with a thalamic AVM following lateralizing neurologic symptoms. Despite radiosurgical treatment, hemorrhage followed consequently causing extensive neurologic injury and death. This case emphasizes the need for close follow up and coordination within a medical home for children with developmental disabilities. A multidisciplinary team approach is ideal to allow detection of subtle neurologic changes over time that may be masked as behavioral difficulties.
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Affiliation(s)
- Veena Sison
- Developmental Pediatrics, Children's Hospital Colorado, Aurora, CO.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.,Southern California Kaiser Permanente Medical Group, Woodland Hills, CA
| | | | - Robert Breeze
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO
| | - Terry Hall
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.,JFK Partners, University of Colorado School of Medicine, Aurora, CO
| | - Pamela McKenzie
- Developmental Pediatrics, Children's Hospital Colorado, Aurora, CO.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Nicole Tartaglia
- Developmental Pediatrics, Children's Hospital Colorado, Aurora, CO.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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Ding D, Starke RM, Liu KC, Crowley RW. Cortical plasticity in patients with cerebral arteriovenous malformations. J Clin Neurosci 2016; 22:1857-61. [PMID: 26256067 DOI: 10.1016/j.jocn.2015.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/20/2015] [Indexed: 10/22/2022]
Abstract
The aim of this review is to ascertain the evidence for cortical plasticity in arteriovenous malformation (AVM) patients. Chronic hypoperfusion due to vascular steal from cerebral AVM can result in a translocation of eloquent neurological functions to other brain areas, a phenomenon known as cortical plasticity. We performed a systematic literature review of the studies that have evaluated cortical plasticity in AVM patients. A total of 22 studies from 1996 to 2014 were included for the analyses. The evaluation of cortical plasticity was performed prior to AVM intervention in 109 patients, and during or after AVM intervention in 18. The most commonly assessed neurological functions were motor in 85% and language in 11% of the former cohort, and motor in 78% and language, cognition, and memory each in 39% of the latter cohort. Functional MRI was the most frequently used method for evaluating cortical plasticity, and was performed in 63% of the former and 56% of the latter cohort. In conclusion, cortical plasticity appears to be influenced by both AVM pathogenesis and intervention. Given the limited evidence that is currently available for cortical plasticity in AVM patients, further studies are warranted to determine its incidence and impact on long term clinical outcomes.
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Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA.
| | - Robert M Starke
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - R Webster Crowley
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
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7
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Chávez CL, Yáñez G, Catroppa C, Rojas S, Escartin E, Hearps SJ, García A. Adolescents with vascular frontal lesion: A neuropsychological follow up case study. Neurocirugia (Astur) 2016; 27:136-43. [DOI: 10.1016/j.neucir.2015.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/11/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022]
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Long-term sequelae after acquired pediatric hemorrhagic cerebellar lesions. Childs Nerv Syst 2011; 27:923-31. [PMID: 21190024 DOI: 10.1007/s00381-010-1357-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the present study was to assess cognitive, affective, and motor long-term sequelae after acquired focal pediatric cerebellar lesions. METHODS Eight patients with a history of isolated acquired hemorrhagic cerebellar lesions before the age of 13 participated in this study. All participants underwent a neurologic examination, including the Zurich Neuromotor Assessment (ZNA) and the International Cooperative Ataxia Rating Scale (ICARS). Cognitive functions have been evaluated with a general cognitive assessment and an extensive neuropsychological battery. Furthermore, patients and parents filled in questionnaires about quality of life and possible behavioral or emotional problems. RESULTS The results revealed that all patients exhibited motor problems (ZNA). Most participants had further restricted oculomotor movements (ICARS). Age at injury and the full scale IQ were significantly positively correlated (Pearson correlation 0.779; p = 0.023). Conversely, no overall neuropsychological profile could be identified except for marginally reduced reaction times and susceptibility to interference. In addition, borderline results in semantic and phonemic word fluency tasks were apparent. A dysexecutive syndrome was diagnosed in one patient. However, verbal performance and reading abilities were non-pathologic in all participants. The patients reported having a good quality of life without major physical restrictions. CONCLUSIONS Emotional disturbances and the presence of a mild cerebellar cognitive affective syndrome (as frequently described in adult patients) could only be confirmed in adolescents with vermis lesions. Nevertheless, in laboratory conditions, neuropsychological impairments were present in all patients. Heterogeneity of age at injury and exact lesion site may have led to interpersonal differences in neuropsychological outcome.
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Johnson AR, DeMatt E, Salorio CF. Predictors of outcome following acquired brain injury in children. ACTA ACUST UNITED AC 2009; 15:124-32. [PMID: 19489083 DOI: 10.1002/ddrr.63] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acquired brain injury (ABI) in children and adolescents can result from multiple causes, including trauma, central nervous system infections, noninfectious disorders (epilepsy, hypoxia/ischemia, genetic/metabolic disorders), tumors, and vascular abnormalities. Prediction of outcomes is important, to target interventions, allocate resources, provide education to family or caregivers, and begin appropriate planning for the future. Researchers have identified several factors associated with better or worse outcomes after ABI, including variables related to the injury itself, postinjury factors related to intervention or trajectory of recovery, and preinjury or demographic factors. When examining the scientific literature, it is important to identify how "outcome" is defined, as the predictors may change depending on the outcome studied. In addition, key variables may be specific to the etiology of injury. Therefore, predictors of outcome cannot be generalized across the various etiologies of ABI, and this review will discuss predictors within the context of multiple etiologies of ABI. This article reviews the current literature on predicting outcomes after pediatric ABI, and areas in need of further research are discussed.
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Affiliation(s)
- Abigail R Johnson
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205, USA
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Lantz ER, Meyers PM. Neuropsychological effects of brain arteriovenous malformations. Neuropsychol Rev 2008; 18:167-77. [PMID: 18500557 DOI: 10.1007/s11065-008-9060-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 03/24/2008] [Indexed: 11/24/2022]
Abstract
Brain arteriovenous malformations (AVM's) are developmental, chronic lesions that provide unique information about the human brain and can be a useful model for neuroscientists to study cerebral reorganization and hemodynamics. We review the neuroanatomy, epidemiology, natural history, imaging and treatment of brain AVMs, and provide a model with which to better understand neuropsychological functioning and brain reorganization. We suggest that future studies must exclude ruptured AVMs if they wish to further explain focal neurological/cognitive deficits associated with this neurovascular anomaly.
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Affiliation(s)
- Emily R Lantz
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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