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Handbook of Clinical Neurology

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https://www.readbyqxmd.com/read/28552164/foreword
#1
EDITORIAL
Michael J Aminoff, Fran├žois Boller, Dick F Swaab
No abstract text is available yet for this article.
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552163/preface
#2
EDITORIAL
Robert F Spetzler, Karam Moon, Rami O Almefty
No abstract text is available yet for this article.
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552162/epidemiology-clinical-presentation-diagnostic-evaluation-and-prognosis-of-cerebral-dural-arteriovenous-fistulas
#3
Mohamed Samy Elhammady, Sudheer Ambekar, Roberto C Heros
Dural arteriovenous fistulas are abnormal communications, within the dural leaflets, between meningeal arteries and dural venous sinuses and/or subarachnoid veins. Although many fistulas remain clinically silent and do not require treatment, presence of cortical venous reflux, intracranial bleed, and intolerable symptoms are the main indications for treatment. A thorough understanding of the natural history is of prime importance in the decision making and management of these lesions. In this chapter we discuss the epidemiology and natural history of intracranial dural arteriovenous fistulae...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552161/multimodality-management-of-cerebral-arteriovenous-malformations
#4
Mohan Narayanan, Gursant S Atwal, Peter Nakaji
Arteriovenous malformations (AVMs) of the brain are diverse lesions that vary widely in location, size, and complexity. Treatment options for AVMs are correspondingly complex. Complete elimination of an AVM is required to protect patients from future hemorrhage. Decisions about whether to treat and, if so, how to treat these lesions depend on the characteristics of the patient and the specific characteristics of the AVMs. The characteristics of AVMs are often summarized through grading systems. Some AVMs can be managed conservatively, whereas others can be managed with microsurgical resection, radiosurgical ablation, or endovascular embolization, either individually or in combination...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552160/radiosurgery-for-the-management-of-cerebral-arteriovenous-malformations
#5
Dale Ding, Robert M Starke, Jason P Sheehan
Cerebral arteriovenous malformations (AVMs) are rare, unstable vascular lesions which spontaneously rupture at a rate of approximately 2-4% annually. Stereotactic radiosurgery is a minimally invasive treatment for AVMs, with a favorable risk-to-benefit profile in most patients, with respect to obliteration, hemorrhage, and seizure control. Radiosurgery is ideally suited for small to medium-sized AVMs (diameter <3cm or volume <12cm(3)) located in deep or eloquent brain regions. Obliteration is ultimately achieved in 70-80% of cases and is directly associated with nidus volume and radiosurgical margin dose...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552159/endovascular-management-of-arteriovenous-malformations
#6
Bradley A Gross, Karam Moon, Cameron G Mcdougall
Arteriovenous malformation (AVM) embolization can serve as a crucial adjunct before surgical resection, a partial approach to target high-risk features, or, rarely, as a curative approach for high-risk, surgically inaccessible lesions. Specifically, embolization is a welcome surgical adjunct to reduce the size of medium to large AVMs, to target perforator supply, and/or to target the deep portion of a nidus. In addition, a crucial role for embolization is the targeting of associated aneurysms, particularly in the setting of a ruptured lesion, regardless of the subsequent therapeutic modality...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552158/epidemiology-genetics-pathophysiology-and-prognostic-classifications-of-cerebral-arteriovenous-malformations
#7
Alp Ozpinar, Gustavo Mendez, Adib A Abla
Arteriovenous malformations (AVMs) are vascular deformities involving fistula formation of arterial to venous structures without an intervening capillary bed. Such anomalies can prove fatal as the high arterial flow can disrupt the integrity of venous walls, thus leading to dangerous sequelae such as hemorrhage. Diagnosis of these lesions in the central nervous system can often prove challenging as intracranial AVMs represent a heterogeneous vascular pathology with various presentations and symptomatology. The literature suggests that most brain AVMs (bAVMs) are identified following evaluation of the etiology of acute cerebral hemorrhage, or incidentally on imaging associated with seizure or headache workup...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552157/surgical-management
#8
Michael K Morgan
Surgical management includes selection of patients for surgery, performing the technical procedure of brain arteriovenous malformation (bAVM) resection and perioperative management that maximize the chance for the best outcome. In general the Spetzler-Ponce class (SPC) can divide patients into those with good evidence that surgery is appropriate in most cases (SPC A), those in whom surgery should only be considered occasionally with highly nuanced indications (SPC C), and surgery may be appropriate having made a detailed analysis of patient (including age), clinical (including mode of presentation), and AVM characteristics (including diffuseness), and a comparative analysis of outcomes with alternate management pathways for SPC B cases...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552156/seizures-associated-with-cerebral-arteriovenous-malformations
#9
Johannes Schramm
Various types of seizures and epilepsy are associated with 20-45% of cerebral arteriovenous malformations (AVMs). The necessity to differentiate between occasional seizures, epilepsy with repetitive seizures, and the much rarer drug-resistant epilepsy (DRE) is underlined. It is clear that where there is frequent seizures or DRE, vascular surgeons should take epilepsy surgery aspects into account. The epidemiology of AVM-associated seizures, assumed pathophysiologic mechanisms, most frequent seizures types, and medical treatment are described...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552155/pharmacotherapy-for-cavernous-malformations
#10
Robert F Rudy, Rose Du
Cerebral cavernous malformations, vascular abnormalities comprised of endothelial cells in the absence of connective tissue or muscle, are often epileptogenic and often treated initially with antiepileptic drugs. This chapter discusses the role of pharmacotherapy in managing focal epilepsy secondary to cavernous malformations in adults, children, and pregnant women. Several drugs are available and potentially efficacious in suppressing seizures stemming from cavernous malformations. In addition, antiepileptic pharmacotherapy following surgical resection is indicated to decrease the risk of postoperative seizures...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552154/spinal-cavernous-malformations
#11
Aaron J Clark, Doris D Wang, Michael T Lawton
Spinal cavernous malformations are rare intramedullary vascular lesions of the central nervous system. Most are located in the thoracic spine. Patients present with either acute neurologic deficit or gradual deterioration. Weakness is the most common presenting symptom. The annual hemorrhage risk is 2.1%. Diagnosis is made by magnetic resonance imaging as these lesions are occult on angiography. Surgical removal is indicated in patients with hemorrhage and neurologic deficit. All lesions are approached posteriorly by laminectomy...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552153/thalamic-cavernous-malformations
#12
Christina E Sarris, Gursant S Atwal, Peter Nakaji
Cavernous malformations of the thalamus represent a particularly complex subset of cavernous malformations because of the highly eloquent nature of the involved tissue and their deep location. The decision about whether to operate on any individual lesion depends on the specific location of the lesion within the thalamus, the nature of the patient's symptoms, and the patient's history. When surgery is recommended, the approach must be chosen carefully. Each part of the thalamus is reached by a different surgical approach...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552152/brainstem-and-cerebellar-cavernous-malformations
#13
Gursant S Atwal, Christina E Sarris, Robert F Spetzler
Cavernous malformations are vascular lesions that occur throughout the central nervous system, most commonly in the supratentorial location, with brainstem and cerebellar cavernous malformations occurring more rarely. Cavernous malformations are associated with developmental venous anomalies that occur sporadically or in familial form. Patients with a cavernous malformation can present with headaches, seizures, sensorimotor disturbances, or focal neurologic deficits based on the anatomic location of the lesion...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552151/supratentorial-cavernous-malformations
#14
Jason A Ellis, Daniel L Barrow
Supratentorial cavernous malformations are uncommon cerebral vascular lesions that may present many unique challenges for treating physicians. The vast majority will be discovered during workup for seizures or after symptomatic intracerebral hemorrhage. Supratentorial cavernous malformations are increasingly being discovered incidentally in patients who obtain brain imaging for unrelated reasons. Management strategies including watchful waiting, antiepileptic drug therapy, microsurgery, or an expanding array of "minimally invasive" therapies...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552150/developmental-venous-anomalies
#15
Michael A Mooney, Joseph M Zabramski
Developmental venous anomalies (DVAs) are relatively common lesions, present in up to 3% of the population. The defining characteristic of these lesions is the confluence of radially oriented veins into a single dilated venous channel. DVAs are also known as cerebral venous angiomas, cerebral venous malformations, and cerebral venous medullary malformations. They are the most common type of cerebral vascular malformation found on autopsy studies, and they are often encountered as incidental findings on neuroimaging studies...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552149/pathology-of-cavernous-malformations
#16
Efrem M Cox, Nicholas C Bambakidis, Mark L Cohen
Cavernous malformations (CMs) are low-pressure angiographically occult lesions, composed of blood-filled sinusoidal locules known as "caverns." Although these lesions were once believed to be congenital in nature, there is compelling evidence to support de novo formation of CMs as well. They can occur as sporadic lesions or be inherited in an autosomal-dominant phenotype in familial forms of the disease. The pathophysiology of CMs is commonly believed to be due to abnormal vascular pathology. Three genes, CCM1, CCM2, and CCM3, have been extensively studied for their role in vascular pathology, resulting in abnormal angiogenesis and compromising the structural integrity of vessel endothelial cell...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552148/arteriovenous-malformations-epidemiology-clinical-presentation-and-diagnostic-evaluation
#17
Joshua W Osbun, Matthew R Reynolds, Daniel L Barrow
Brain arteriovenous malformations (AVMs) represent an uncommon disease of the central nervous system characterized by an arteriovenous shunt in which one or multiple arterial pedicles feed into a vascular nidus, creating early drainage into a venous outflow channel. These lesions are considered to be congenital and can come to clinical attention in a variety of ways such as seizure, intracranial hemorrhage, chronic headache or progressive neurological deficit. We focus on the epidemiology, clinical presentation and diagnostic evaluation in this chapter...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552147/radiology-and-imaging-for-cavernous-malformations
#18
Kevin Y Wang, Oluwatoyin R Idowu, Doris D M Lin
Cavernous malformations are low-flow vascular malformations that are histologically characterized by the lack of mural elements of mature vascular structures and intervening parenchymal neural tissue. They are often clinically quiescent, and may grow, bleed, and regress, but can also manifest clinically as neurologic deficits or seizures in the setting of an acute hemorrhage. The low-flow nature of cavernous malformations renders them inherently occult on cerebral angiography. Magnetic resonance imaging has become the mainstay imaging modality in evaluating cavernous malformations, producing characteristic imaging features that usually provide a straightforward diagnosis...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552146/epidemiology-of-cavernous-malformations
#19
Hannah E Goldstein, Robert A Solomon
Cavernous malformations, accounting for approximately 5-15% of all vascular abnormalities in the central nervous system, are angiographically occult lesions which most often present with seizures, rather than acute hemorrhage. Widely variable across populations, the incidence of cavernous malformations has been reported to be 0.15-0.56 per 100 000 persons per year, with an annual hemorrhage rate of 0.6-11% per patient-year. Seen in 0.17-0.9% of the population, up to one-half are familial, and at least three gene loci have been associated with a familial form, more common among Hispanic Americans...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28552145/natural-history-of-spinal-cavernous-malformations
#20
Marc Otten, Paul Mccormick
Spinal cavernous malformations are intramedullary vascular lesions. They have low pressure and flow, so they may take many years to present with clinical symptoms. Because of their relatively benign nature, surgical intervention is not always indicated. An understanding of the natural history of cavernous malformations helps make decisions about when and if to intervene. In patients who do not have surgery, 88.7% have stable or improved neurologic function, whereas 89.3% have these outcomes in the surgical group...
2017: Handbook of Clinical Neurology
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