Background
Brain arteriovenous malformations (AVMs) consist of abnormal connections between arteries and veins via an interposing nidus. While hemorrhage is the most common presentation, unruptured AVMs can present with headaches, seizures, neurological deficits, or be found incidentally. It remains unclear as to what AVM characteristics contribute to pain generation amongst unruptured AVM patients with headaches.
Methods
To assess this relationship, the current study evaluates angiographic and clinical features amongst patients with unruptured brain AVMs presenting with headache. Loyola University Medical Center medical records were queried for diagnostic codes corresponding to AVMs. In patients with unruptured AVMs, we analyzed the correlation between the presenting symptom of headache and various demographic and angiographic features.
Results
Of the 144 AVMs treated at our institution between 1980 and 2017, 76 were unruptured and had sufficient clinical data available. Twenty-three presented with headaches, while 53 patients had other presenting symptoms. Patients presenting with headache were less likely to have venous stenosis compared to those with a non-headache presentation (13 % vs. 36 %, p = 0.044).
Conclusions
Our study suggests that the absence of venous stenosis may contribute to headache symptomatology. This serves as a basis for further study of correlations between AVM angioarchitecture and symptomatology to direct headache management in AVM patients.
Objective: Brain arteriovenous malformations (AVM) are commonly treated with endovascular embolization. Due to the rapid evolution of endovascular technology and lack of consistent practice guidelines regarding AVM embolization, further study of AVM embolization outcomes is warranted.Methods: We conducted a retrospective review of AVMs embolized at a single center from 2002-2019. Patient demographics, AVM characteristics, intention of embolization, and angiographic and clinical outcome after embolization were recorded. We compared the embolization results of those treated with n-butyl cyanoacrylate (n-BCA) and Onyx.Results: Over an 18-year period at our institution, 30 (33%) of 92 AVMs were treated with embolization. n-BCA was used in 12 cases and Onyx in 18 cases. Eighty-seven pedicles were embolized over 47 embolization sessions. Fifty percent of AVMs treated with n-BCA underwent more than one embolization session compared to 22% when Onyx was used. The median total percent volume reduction in the n-BCA AVMs was 52% compared to 51% in Onyx AVMs. There were 2 periprocedural complications in the n-BCA cohort and none in the Onyx cohort.Conclusions: In this small retrospective series, Onyx and n-BCA achieved similar occlusion results, although n-BCA required more sessions and pedicles embolized to do so.
A 13-year-old female with a history of atopy presented with a recurrent and worsening skin rash for 2 months (Figure 1). Around age 3 years, she developed a scaly, pink patch in the shape of a heart on her left dorsal foot. She was treated for tinea corporis with over-the-counter topical antifungal cream and hydrocortisone without response. A presumptive diagnosis of granuloma annulare was subsequently made and she was treated with desoximetasone 0.25% cream and halobetasol propionate 0.05% ointment for 6 months with no improvement. Parents stopped the topical steroids and the lesion resolved on its own several months later. It never itched or caused pain; it did not bother her. Over the next several years, the skin underneath the previous site became thicker and "lumpy." Examination at seven years old revealed a 1.5 cm subtle soft mobile subcutaneous nodule on the left dorsal foot. The lesion remained relatively unchanged until 2 months prior to presentation when she developed new slightly hyperpigmented "lumps" on her left foot. She described it as mildly pruritic. Although not painful, it was uncomfortable especially when wearing shoes and playing sports. Examination revealed multiple slightly violaceous soft mobile subcutaneous nodules extending down the left foot and persistence of the prior lesion.What are the causes of annular skin lesions in the pediatric population and how to treat them? Discussion: Annular lesions acquire their name from the Greek annulus, meaning "ring." These lesions characteristically manifest as circles of erythematous or otherwise discolored skin surrounding centers of normal or abnormal epidermis.
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