BACKGROUND: Unruptured brain arteriovenous malformations (AVMs) represent a complex disease in young healthy adults. Most often AVMs are clinically silent but also can display a neurologic syndrome due to hypoperfusion/hypometabolism in perilesional brain tissue called steal phenomenon. CASE DESCRIPTION: A 34-year-old woman was admitted to a secondary neurologic center complaining of a right hemiparesis and secondarily generalized seizures. Computed tomography scan and magnetic resonance imaging of the brain showed a left prerolandic AVMwithout signs of acute or previous bleedings. Digital subtraction angiography confirmed a left juxta-central AVM, with a diffuse pattern, fed by hypertrophic rolandic branches from the left middle cerebral artery. An F-18-fluorodeoxyglucose positron emission tomography-magnetic resonance imaging scan was performed 3 days after the critical episode. A significant hypometabolism in parenchymal regions ipsilaterally to the AVM was detected. Two embolization sessions were performed by means of N-butyl cyanoacrylate glue. At the end of the second procedure, a decrease of the shunt-flow and AVM size was observed. Six months later, F-18-fluorodeoxyglucose positron emission tomography-magnetic resonance imaging scan showed persistent hypometabolism located in the AVM area, with a significant improvement of the cortical hemispheric hypometabolism. The patient was asymptomatic and was sent to stereotactic radiosurgery to complete the treatment. CONCLUSIONS: In clinical practice, irritative symptoms in patients with unruptured AVMs could lead to erroneous evaluations. In case of fluctuating clinical syndromes, like our case, establishing that symptoms are related to a steal phenomenon is usually difficult.

F-18-Fluorodeoxyglucose Positron Emission Tomography-Magnetic Resonance Monitoring of Brain Metabolic Changes in a Case of Arteriovenous Malformatione-Related Steal Phenomenon Symptoms / Anglani, Mariagiulia; Cecchin, Diego; Cester, Giacomo; Simonato, Davide; Baracchine, Claudio; Della Puppa, Alessandro; Causin, Francesco. - In: WORLD NEUROSURGERY. - ISSN 1878-8750. - ELETTRONICO. - 126(2019), pp. 276-279. [10.1016/j.wneu.2019.02.167]

F-18-Fluorodeoxyglucose Positron Emission Tomography-Magnetic Resonance Monitoring of Brain Metabolic Changes in a Case of Arteriovenous Malformatione-Related Steal Phenomenon Symptoms

Della Puppa, Alessandro;
2019

Abstract

BACKGROUND: Unruptured brain arteriovenous malformations (AVMs) represent a complex disease in young healthy adults. Most often AVMs are clinically silent but also can display a neurologic syndrome due to hypoperfusion/hypometabolism in perilesional brain tissue called steal phenomenon. CASE DESCRIPTION: A 34-year-old woman was admitted to a secondary neurologic center complaining of a right hemiparesis and secondarily generalized seizures. Computed tomography scan and magnetic resonance imaging of the brain showed a left prerolandic AVMwithout signs of acute or previous bleedings. Digital subtraction angiography confirmed a left juxta-central AVM, with a diffuse pattern, fed by hypertrophic rolandic branches from the left middle cerebral artery. An F-18-fluorodeoxyglucose positron emission tomography-magnetic resonance imaging scan was performed 3 days after the critical episode. A significant hypometabolism in parenchymal regions ipsilaterally to the AVM was detected. Two embolization sessions were performed by means of N-butyl cyanoacrylate glue. At the end of the second procedure, a decrease of the shunt-flow and AVM size was observed. Six months later, F-18-fluorodeoxyglucose positron emission tomography-magnetic resonance imaging scan showed persistent hypometabolism located in the AVM area, with a significant improvement of the cortical hemispheric hypometabolism. The patient was asymptomatic and was sent to stereotactic radiosurgery to complete the treatment. CONCLUSIONS: In clinical practice, irritative symptoms in patients with unruptured AVMs could lead to erroneous evaluations. In case of fluctuating clinical syndromes, like our case, establishing that symptoms are related to a steal phenomenon is usually difficult.
126
276
279
Anglani, Mariagiulia; Cecchin, Diego; Cester, Giacomo; Simonato, Davide; Baracchine, Claudio; Della Puppa, Alessandro; Causin, Francesco
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2158/1172544
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