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He Y, Tao Y, Tian J, Bao M, Zhang M, Huang Q, Li H, Chang X, Li K, Liu P, Guo L, Qin X, Huang C, Wu B. Unveiling the domino effect: a nine-year follow-up on pentalogy of central nervous system induced by a large unruptured cerebral arteriovenous malformation: a case report and literature review. Front Neurol 2024; 15:1365525. [PMID: 38846033 PMCID: PMC11153792 DOI: 10.3389/fneur.2024.1365525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/22/2024] [Indexed: 06/09/2024] Open
Abstract
Background The disruption of intracranial fluid dynamics due to large unruptured cerebral arteriovenous malformation (AVM) commonly triggers a domino effect within the central nervous system. This phenomenon is frequently overlooked in prior clinic and may lead to catastrophic misdiagnoses. Our team has documented the world's first case of so-called AVM Pentalogy (AVMP) induced by a AVM. Clinical presentation and result A 30-year-old female was first seen 9 years ago with an occasional fainting, at which time a huge unruptured AVM was discovered. Subsequently, due to progressive symptoms, she sought consultations from several prestigious neurosurgical departments in China, where all consulting neurosurgeons opted for conservation treatment due to perceived surgical risks. During the follow-up period, the patient gradually presented with hydrocephalus, empty sella, secondary Chiari malformation, syringomyelia, and scoliosis (we called as AVMP). When treated in our department, she already displayed numerous symptoms, including severe intracranial hypertension. Our team deduced that the hydrocephalus was the primary driver of her AVMP symptoms, representing the most favorable risk profile for intervention. As expected, a ventriculoperitoneal shunt successfully mitigated all symptoms of AVMP at 21-months post-surgical review. Conclusion During the monitoring of unruptured AVM, it is crucial to remain vigilant for the development or progression of AVMP. When any component of AVMP is identified, thorough etiological studies and analysis of cascade reactions are imperative to avert misdiagnosis. When direct AVM intervention is not viable, strategically addressing hydrocephalus as part of the AVMP may serve as the critical therapeutic focus.
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Affiliation(s)
- Yunsen He
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Ye Tao
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jing Tian
- Department of Neurosurgery, The People’s Hospital of Zhongjiang, Deyang, Sichuan, China
| | - Mingbin Bao
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Mengjun Zhang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinjiang Huang
- Department of Neurosurgery, Wenjiang District People’s Hospital of Chengdu, Chengdu, China
| | - Hongliang Li
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Xinxin Chang
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Kun Li
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Ping Liu
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lili Guo
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiaohong Qin
- Department of Neurosurgery, The People’s Hospital of Zhongjiang, Deyang, Sichuan, China
| | - Caiquan Huang
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Bo Wu
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Taylor HL, Dove EJ, Elverum CL, Gunther WM. Sudden death caused by ruptured brain arteriovenous malformation in an adolescent with autism spectrum disorder. J Forensic Sci 2022; 67:1734-1738. [PMID: 35246983 DOI: 10.1111/1556-4029.15024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
Brain arteriovenous malformations (bAVMs) are infrequent disorders in the pediatric population. The rupture of a bAVM is a clinical emergency often followed by death. Autism spectrum disorder shares a number of symptoms with AVM malformation; this may impede antemortem diagnosis. An 11-year-old boy with autism spectrum disorder (ASD) without other medical history died suddenly. Initially, choking on a peanut butter sandwich was suspected; autopsy did not demonstrate aspiration, but identified a ruptured right cerebellar AVM, with the characteristic tortuous vessels. The histology on the lesion confirmed the presence of arterialized veins and showed gliotic tissue and hemosiderin-laden macrophages, consistent with prior bleeding. BAVM pathogenesis is unknown; congenital disease may have several mechanisms including genetic predisposition and familial risk factors; development de novo may occur after hemorrhagic intracranial events such as surgical intervention and head trauma. ASD may present with overlapping symptoms of bAVM and may also interfere with expressing subtle neurologic symptoms to caretakers. ASD and AVM are rarely reported in association.
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Affiliation(s)
- Haley L Taylor
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric J Dove
- Pathology Department, State University at New York (SUNY) University at Buffalo, Buffalo, New York, USA
| | - Cassandra L Elverum
- Children's Hospital of the King's Daughters Child Advocacy Center, Norfolk, Virginia, USA
| | - Wendy M Gunther
- Office of the Chief Medical Examiner, Commonwealth of Virginia, Norfolk, Virginia, USA
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