Publication year: 2011
Source: World Neurosurgery, Available online 28 December 2011
Bradley A. Gross, Rose Du
ObjectiveVasospasm and resultant clinical deterioration due to delayed cerebral ischemia (CD-CDI) are a considerable source of morbidity following aneurysmal SAH. Although a relatively common cause of spontaneous SAH, AVM rupture and ensuing vasospasm is infrequently reported.MethodsWe reviewed our own series of 122 patients with AVMs. Seventy-three patients sustaining 84 hemorrhages were analyzed. We additionally performed a review of the literature of vasospasm following AVM rupture.ResultsSeventy of 84 hemorrhages (83%) had an intraparenchymal component, twenty-seven (32%) a subarachnoid component, and fifty-one (61%) had an intraventricular component. No patients experienced CD-DCI, and only one patient experienced mild angiographic vasospasm following 84 hemorrhages (1.1%). Alternatively, this represents 1 in 34 cases (2.9%) that underwent definitive angiography between the fourth and fifteenth day after the hemorrhage. Nineteen additional cases of angiographic vasospasm after AVM rupture are reported in the literature. The mean age of these patients was 33 years; there was a 1.25:1 female to male predominance in this group. Half of these patients had an intraparenchymal hemorrhage, and only 56% of them had SAH. All patients had intraventricular hemorrhage, when assessed. The median time to onset of vasospasm was 9 days. Across 4 series, the rate of angiographic spasm following SAH from an AVM was 6.3% (9/142 cases).ConclusionEven in cases of SAH from AVMs, angiographic vasospasm following AVM rupture is relatively rare. We thus do not recommend empiric delayed angiography to assess for vasospasm in these patients. Nevertheless, it does remain a rare possibility and should be considered in those with CD-DCI.
Júlio Leonardo B. Pereira
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