Cerebrovascular Malformation
Introduction
Introduction to cerebrovascular malformation Cerebrovascular malformation is a congenital, non-neoplastic dysplasia of the cerebral blood vessels. It refers to the abnormal number and structure of blood vessels in the brain caused by cerebral vascular development disorders, and has an effect on normal cerebral blood flow. The rupture of bleeding is mainly manifested as intracerebral hemorrhage or hematoma. It is more common in young people and is diagnosed at an average age of 20-40 years. Cerebrovascular malformation, also known as hemangioma, is a non-authentic tumor. It is a congenital cerebral vascular dysplasia. There are many types of clinical cerebral vascular dysplasia. Among them, arteriovenous malformations are more common. According to the size of the deformed vascular mass, the clinical classification is large, medium, and Small lesions. The disease is more common in men, more common in young people. Clinical manifestations of abnormal vascular rupture are the most common symptoms, some patients with epilepsy as the first symptom; due to "stolen blood" phenomenon, local cerebral ischemia can cause brain atrophy, mental decline, mental disorders can exist. If the bleeding is severe, cerebral palsy occurs, and if it is not treated in time, it can often be fatal. basic knowledge The proportion of illness: 0.002% Susceptible people: more common in young people, more common in men Mode of infection: non-infectious Complications: convulsions and convulsions hydrocephalus congestive heart failure
Cause
Causes of cerebral vascular malformation
1. Arteriovenous malformation (AVM)
It is divided into two types: typical and Galen's large venous malformation: clinical symptoms of AVM, in addition to occupancy and oppression, stealing blood is also an important cause.
The intracranial vascular murmur is obvious. Hydrocephalus can occur during infancy. The mortality rate is high, about 50% of deaths. If the blood flow is not large, the heart failure is light, and there may be repeated transient hemiplegia. It is difficult to treat and can be staged.
2, congenital intracranial cystic aneurysm
Less common in children. It mainly occurs in the internal carotid artery at the base of the skull, the anterior and posterior communicating artery, or the vertebral basilar artery. The elastic layer and the muscular layer of the artery are weakened, and the tumor is prominent, usually below 1 cm.
3, venous hemangioma
More common, occurs in the cerebral hemisphere, more common in older children. Neurological images showed vascular malformations ranging from 1 mm to several cm in diameter, and about 15% had calcification.
4, cavernous hemangioma
More common in the cerebral hemisphere, is a dense thin-walled blood vessel. Childhood is often asymptomatic and accidentally discovered. Generally, symptoms appear in older children or adults, mainly epilepsy, headache, and intracerebral hemorrhage. Common familial cases are dominant inheritance. This disease can also be seen in the retina, liver, kidney, skin similar to cavernous hemangioma.
Prevention
Cerebrovascular malformation prevention
Closely observe the vital signs, pay attention to the occurrence of intracranial hematoma, shock, cerebral edema, and deal with it accordingly; for patients who continue to lower blood pressure after surgery to treat "normal perfusion pressure breakthrough syndrome", there should be special treatment and care. Until the blood pressure returns to normal.
Complication
Cerebrovascular malformation complications Complications, convulsions and convulsions, hydrocephalus, congestive heart failure
Common complications of cerebral vascular malformation: due to compression or rupture of the surrounding tissue, causing convulsions, paralysis or aphasia, due to increased intracranial pressure, conscious coma, accompanied by hematoma, hydrocephalus, neonatal congestive heart failure, Difficulty breathing and cyanosis, infants can develop obstructive hydrocephalus and mental retardation. Cranial nerve palsy, periodic migraine, etc.
Symptom
Symptoms of cerebral vascular malformation Common symptoms Hemiplegia intracranial hemorrhage Epilepsy and epileptic seizures Cerebral palsy faint myelination delayed mental retardation
1, the general symptoms: pulsatile headache, located on the side of the disease, may be associated with intracranial vascular murmur.
2, bleeding: often the first symptom, manifested as subarachnoid hemorrhage or intracerebral hematoma.
3, epilepsy: can be the first symptom or after the bleeding, mostly for systemic seizures or localized seizures, localized seizures have a localized significance.
4, local source symptoms: on-screen lesions may have mental abnormalities, hemiplegia, aphasia, loss of reading, miscalculation and so on. Most of the people behind the scenes are dizzy, double vision, tremors and gait instability.
Examine
Examination of cerebral vascular malformations
1, cerebral angiography
The cerebral arteriovenous malformation has the following typical manifestations: 1 shows the abnormally large vessel 2 feeding artery and drainage vein with local circulation to accelerate 3 blood flow shunt phenomenon 4 hematoma performance.
2, CT performance
There is a typical CT manifestation before rupture of cerebral arteriovenous malformation.
3, MRI performance
1 The vascular component of cerebral arteriovenous malformation is characterized by a cluster-like, reticular distribution of no-signal vascular shadows. 2 arteriovenous malformation hemorrhage, hematoma, T1 and T2 weighted image changes and similar causes of hematoma.
Diagnosis
Diagnosis and differentiation of cerebrovascular malformation
1. Adolescent patients have a history of headache, epilepsy and subarachnoid hemorrhage.
2, the clinical manifestations of acute intracranial spontaneous blood, or seizures, or obvious signs of local signs.
3, head CT: plain lesions are often low density, there is also low density around, if the intracerebral hemorrhage can be seen high density, enhanced vascular area is high density, sometimes visible blood supply artery and drainage vein.
4, head MRI: better than CT, not only can display abnormal blood vessels and surrounding brain tissue, but also distinguish between bleeding and calcification. MRI angiography can improve the diagnosis rate of deformed vascular mass.
5. Cerebral angiography: The most reliable and important diagnostic method, the vascular mass, the blood supply artery and the early drainage vein appear in the arterial phase.
