Spontaneous appearance of de novo intracranial arteriovenous malformation in hepatic cirrhosis - 01/12/19
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Highlights |
• | Intracranial arteriovenous malformation can also appear during late adulthood. |
• | Hepatopathy is linked with de novo AVM formation. |
• | AVM formation implicates both venous congestion/thrombosis and arterial phase-related changes. |
Abstract |
Background |
Intracranial arteriovenous malformations (AVMs) are rare lesions that can be congenital or acquired in early childhood, with fatal outcome in approximately 30% of cases. De novo formation during adulthood without established predisposing vascular pathology or previous brain insult is even less frequent.
Case Description |
We present a case of de novo brain AVM in an alcoholic Child-B cirrhosis setting. Thirty previously reported cases presented de novo AVM in patients of all ages that had another previous brain pathology or insult, such as AVM resection. Seventeen of those cases occurred in adult patients, with only 2 showing no significant predisposing factor. The present pathophysiological review covers and completes Mullan's hemodynamic “two-hit” model, associating probable thrombotic predisposition to AVM with brain insult triggering a later stage based on angiogenic stimuli.
Conclusions |
This case report and literature review renews previously discussed hemodynamic theories and contributes to a fuller understanding of the pathogenesis and progression of AVM. We postulate a causal link between hepatopathy and de novo AVM, which should be strengthened and interpreted based on recent genetic data and future prospective studies.
Le texte complet de cet article est disponible en PDF.Keywords : Spontaneous appearance, De novo, Arteriovenous malformation (AVM), Chronic liver disease (cirrhosis), Angiogenesis
Abbreviations : AVF, AVM, Child, CT, CVM, DSA, DVA, HHT, HPS, IL-6, MMP-3 and MMP-9, MRI, PAVF, NO, TGF, TNF- α, VEG
Plan
Vol 65 - N° 6
P. 393-396 - décembre 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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