Impaired peri-nidal cerebrovascular reserve in seizure patients with brain arteriovenous malformations

被引：63

作者：

Fierstra, Jorn ^{[1
,2
,3
]}

Conklin, John ^{[1
]}

Krings, Timo ^{[1
]}

Slessarev, Marat ^{[4
]}

Han, Jay S. ^{[1
,4
]}

Fisher, Joseph A. ^{[4
]}

terBrugge, Karel ^{[1
]}

Wallace, M. Christopher ^{[2
]}

Tymianski, Michael ^{[2
]}

Mikulis, David J. ^{[1
]}

机构：

[1] Univ Toronto, Joint Dept Med Imaging, Toronto Western Hosp, Div Neuroradiol, Toronto, ON M5T 2S8, Canada

[2] Univ Toronto, Toronto Western Hosp, Dept Surg, Div Neurosurg, Toronto, ON M5T 2S8, Canada

[3] Univ Med Ctr, Rudolf Magnus Inst Neurosci, NL-3584 CG Utrecht, Netherlands

[4] Univ Toronto, Toronto Gen Hosp, Dept Anaesthesia, Toronto, ON M5G 2C4, Canada

来源：

BRAIN | 2011年 / 134卷

关键词：

Cerebral arterio-venous malformations; seizures; epilepsy; cerebral autoregulation; cerebrovascular reserve; BOLD MRI; steal phenomenon; venous congestion; LEVEL-DEPENDENT MRI; CLINICAL PRESENTATION; REACTIVITY; STEAL; HEMORRHAGE; FLOW;

D O I：

10.1093/brain/awq286

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Epileptic seizures are a common presentation in patients with newly diagnosed brain arteriovenous malformations, but the pathophysiological mechanisms causing the seizures remain poorly understood. We used magnetic resonance imaging-based quantitative cerebrovascular reactivity mapping and conventional angiography to determine whether seizure-prone patients with brain arteriovenous malformations exhibit impaired cerebrovascular reserve or morphological angiographic features predictive of seizures. Twenty consecutive patients with untreated brain arteriovenous malformations were recruited (10 with and 10 without epileptic seizures) along with 12 age-matched healthy controls. Blood oxygen level-dependent MRI was performed while applying iso-oxic step changes in end-tidal partial pressure of CO2 to obtain quantitative cerebrovascular reactivity measurements. The brain arteriovenous malformation morphology was evaluated by angiography, to determine to what extent limitations of arterial blood supply or the presence of restricted venous outflow and tissue congestion correlated with seizure susceptibility. Only patients with seizures exhibited impaired peri-nidal cerebrovascular reactivity by magnetic resonance imaging (0.11 +/- 0.10 versus 0.25 +/- 0.07, respectively; P < 0.001) and venous drainage patterns suggestive of tissue congestion on angiography. However, cerebrovascular reactivity changes were not of a magnitude suggestive of arterial steal, and were probably compatible with venous congestion in aetiology. Our findings demonstrate a strong association between impaired peri-nidal cerebrovascular reserve and epileptic seizure presentation in patients with brain arteriovenous malformation. The impaired cerebrovascular reserve may be associated with venous congestion. Quantitative measurements of cerebrovascular reactivity using blood oxygen level-dependent MRI appear to correlate with seizure susceptibility in patients with brain arteriovenous malformation.

引用

页码：100 / 109

页数：10

共 31 条

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