Spontaneous thrombosis of the main draining vein revealing an unruptured brain arteriovenous malformation

Spontaneous thrombosis of deep brain arteriovenous malformation in a patient with intraventricular and subarachnoid hemorrhage

The most common manifestation of brain arteriovenous malformations (BAVM) is intracranial hemorrhage. The incidence of ruptured BAVM is 3.5 per 100,000 people per year. The mortality rate of ruptured BAVM within 1 month after diagnosis was 12.7%. Spontaneous thrombosis occurs in less than 1.5% of ruptured BAVMs. This phenomenon was still elusive. Up until now, the gold standard of imaging examination has been cerebral digital subtraction angiography (DSA), whose sensitivity and specificity reach 100%. We reported the spontaneous thrombosis of a ruptured deep BAVM. An 18-year-old woman presented with severe headache and vomiting. The patient also complained of seizures. There was no body weakness, skewed face, or slurred speech. Cerebral computed tomography (CT) showed extensive hemorrhage in the ventricular system and subarachnoid space. Cerebral DSA showed a left subcortical BAVM and was found to have spontaneous thrombosis 3 weeks later when the patient was about to be embolized. Spontaneous thrombosis of ruptured BAVM may occur after intracranial hemorrhage. In this patient, spontaneous thrombosis occurred within 3 weeks.

Spontaneous Regression of Cerebral Arteriovenous Malformation Following Onyx Embolization

Little is known about the natural history of arteriovenous malformations (AVM) and less is known about their potential for spontaneous regression. The advent of endovascular treatment for embolization or pre-surgical embolization of cerebral arteriovenous malformations (cAVM) has seen several reports of spontaneous regression of partial embolization of cAVMs surface in the literature.

A 66-year-old patient had an initial diagnostic cerebral angiogram revealing a left frontoparietal region Spetzler-Martin (SM) grading 4 cAVM. The patient underwent three stages of embolization over eight months leading to a 90% reduction in nidal volume, before being lost to follow up for six years. A six-vessel diagnostic cerebral angiogram was performed at that time to assess for any interval changes and surprisingly, the previously visualized left frontoparietal AVM had regressed. There was evidence of prior onyx embolization with no residual filling or recurrence.

Spontaneous regression after partial embolization may be under-reported or the natural history is simply unable to temporally unfold because the typical treatment course results in surgery following partial embolization. Given the potential to forgo the risks of an open procedure, we believe this topic deserves further attention.

Spontaneous regression of a thrombosed cerebral arteriovenous malformation in a patient with a prothrombotic state associated with multiple myeloma: A case report and literature review

Background

Cerebral arteriovenous malformations (AVMs) are pathologic communications between veins and arteries of the brain vasculature. Its spontaneous regression is rare, and many factors have been described in the effort to explain this phenomenon, including a hypercoagulable state.

Case Description

We present the case of a spontaneous unruptured AVM regression in a patient where thrombosis of the malformation was found, probably due to a prothrombotic state associated with multiple myeloma (MM).

Conclusion

We aim to contribute to the study of this rare phenomenon, presenting the relationship between a hypercoagulable state caused by MM and the spontaneous AVM regression that has not been previously reported.

Spontaneous thrombosis in main draining veins of unruptured cerebral arteriovenous malformations: A case report

RATIONALE

Spontaneous obliteration of unruptured arteriovenous malformations (AVMs) is rare. It occurs in <1.5% of cerebral AVMs and only 7 cases have been reported so far. This phenomenon, together with the formation and outcome of cerebral AVMs, remains barely understood. In this work, we presented a case that spontaneous venous thrombosis in main draining veins of an unruptured AVM were confirmed, and reviewed the relevant literature in order to discuss the possible mechanisms.

PATIENT CONCERNS

Clinical data and treatment of a 33-year-old man with a preliminary diagnosis as right parietal mass with secondary epilepsy.

DIAGNOSES

The diagnosis of the mass was a right parietal arteriovenous malformation (AVM) that was 3.5 cm in size and supplied mainly by multiple feeders of right middle cerebral artery (MCA).

INTERVENTIONS

An operation was performed with meticulous hemostasis of the extracranial soft tissue and the AVM was resected completely.

OUTCOMES

The patient's neurological deficits improved postoperatively and he was subsequently discharged 1 week after surgery.

LESSONS

Thrombosis of the draining veins may be due to venous stagnation. Spontaneous venous thrombosis in an unruptured AVM is rare. Spontaneous obliteration of an AVM can occur by 2 mechanisms: occlusion of the feeding arteries or of the draining veins. Surgical or interventional treatment of an unruptured AVM with thrombosed draining veins is highly controversial now. However, we favor an aggressive treatment strategy.