Dwudziestopięcioletnia obserwacja obrazowa niezleczonego olbrzymiego tętniakomózgowiaka o najwyższym stopniu złożoności, powikłanego zawałem mózgu i epilepsją
Twenty-five-year imaging follow-up of an untreated giant Spetzler-Martin grade V Brain arteriovenous malformation associated with cerebral infarction and epilepsy
W skrócie
Pacjent miał ponad 20 lat niezleczoną wadę naczyniową w mózgu, którą wykryto w dzieciństwie. Po latach pojawił się udar mózgu i napady epilepsji, ale dzięki leczeniu objawów funkcja motoryczna się poprawiła. Historia tego pacjenta pokazuje, że choć czasem nie operuje się takich wad z powodu dużego ryzyka, choroby mogą jednak powikłać się poważnymi powikłaniami przez długie lata obserwacji.
Oryginalny abstract (angielski)
Brain arteriovenous malformations (BAVMs) are typically associated with intracranial hemorrhage, whereas ischemic stroke associated with a high-grade BAVM is an exceptionally rare complication. We present the 25-year long-term imaging follow-up of a 39-year-old male with a giant Spetzler-Martin grade V BAVM. Initially diagnosed at age 14 via magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) due to a visual deficit, the complex lesion was managed conservatively owing to prohibitive procedural risks. Twenty-five years later, the patient presented with acute left limb weakness and recurrent adult-onset epilepsy. Current diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping demonstrated chronic ischemic changes in the bilateral frontal lobes and a new acute-to-subacute infarction in the left parietal lobe. Concurrent MRA and MRI demonstrated a massive 13.5 × 6.3 cm nidus with prominent vascular flow voids and deep venous involvement. The patient received supportive medical management and antiseizure therapy. Motor function showed near-complete recovery at 3 months, although recurrent minor seizures persisted during longer-term follow-up. This 25-year imaging follow-up documents the long-term imaging follow-up of a giant, untreated Spetzler-Martin grade V BAVM and documents the occurrence of delayed ischemic complications during long-term follow-up of a giant BAVM. In extreme-risk, unruptured cases, conservative management with imaging surveillance is a carefully considered option, though it carries ongoing long-term risks.