Co-Incidence of Arterial Aneurysm and Arteriovenous Malformation Based on CT Angiographic Findings in Patients Diagnosed with Spontaneous Subarachnoid Hemorrhage

Document Type : Original Article (s)

Authors

1 MD, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 Professor of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 Associate Professor of Internal Medicine, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Spontaneous subarachnoid hemorrhage (SAH) is one of the most common and acute cerebrovascular events. The cause of this bleeding is often brain aneurysms or arteriovenous malformations (AVM). Co-incidence of these two vascular lesions is associated with an increased risk of cerebral hemorrhage. The purpose of the current study is to investigate the prevalence of cerebral aneurysm along with AVM in patients with spontaneous SAH based on computed tomography (CT) angiographic findings.
Methods: In this cross-sectional and retrospective research, 122 patients were studied. SAH was confirmed based on the results of the CT scan or lumbar puncture. Causes such as coagulation disorders and trauma were considered as the exclusion criteria. Vascular lesions have been investigated as a possible cause of SAH using CT angiography.
Findings: The results of the CT angiography images indicated the prevalence of arterial aneurysm in 18 patients (14.7%), AVM in 11 patients (9%), and simultaneous aneurysm and AVM in 4 patients (3.3%). In addition, there was a significant correlation between the presence of vascular lesions and intraventricular and intraparenchymal hemorrhage.
Conclusion: CT angiography results showed a co-incidence of aneurysm and AVM in 3.3% of cases. Also, cerebral vascular lesions are associated with higher degrees of cerebral hemorrhage and multiply the possibility of intraventricular and intraparenchymal bleeding. Awareness of the prevalence of this co-incidence is essential for timely diagnosis and choosing the appropriate therapeutic approach in these patients.

Highlights

Zahra Hashempour: Google Scholar, PubMed

Reza Jalli: Google Scholar, PubMed

Mohammad Javad Fallahi: Google Scholar

Keywords

Main Subjects

References

  1. Ebdan WR, Rabeea SM, Algburi SM. Results of cerebral CTA in subarachnoid hemorrhage. Revista Latinoamericana de Hipertensión 2021; 16(1): 83-8.
  2. Rasyid A, Mesiano T, Kurniawan M, Hidayat R, Mulyadi R, Nugroho SW, et al. Spontaneous subarachnoid hemorrhage due to arteriovenous malformation mimicking migraine: A case report. Radiol Case Rep 2022; 17(3): 790-3.
  3. Chen L, Zhou C. Research on Detection and Diagnosis Technology of Subarachnoid Hemorrhage Based on New Association Classification Algorithm. Scientific Programming 2022; 2022(1): 9496764.
  4. Maher M, Schweizer TA, Macdonald RL. Treatment of spontaneous subarachnoid hemorrhage: guidelines and gaps. Stroke 2020; 51(4): 1326-32.
  5. Galvão J, de Lima DD, Haas LJ, Pereira EM. Predictive models of epidemiological outcomes for patients with subarachnoid hemorrhage. International Journal of Advanced Engineering Research and Science 2022; 9: 4.
  6. Dubosh NM, Bellolio MF, Rabinstein AA, Edlow JA. Sensitivity of early brain computed tomography to exclude aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Stroke 2016; 47(3): 750-5.
  7. Kokkinis C, Vlychou M, Zavras GM, Hadjigeorgiou GM, Papadimitriou A, Fezoulidis IV. The role of 3D-computed tomography angiography (3D-CTA) in investigation of spontaneous subarachnoid haemorrhage: comparison with digital subtraction angiography (DSA) and surgical findings. Br J Neurosurg 2008; 22(1): 71-8.
  8. Howard BM, Hu R, Barrow JW, Barrow DL. Comprehensive review of imaging of intracranial aneurysms and angiographically negative subarachnoid hemorrhage. Neurosurg Focus 2019; 47(6): E20.
  9. Heit JJ, Iv M, Wintermark M. Imaging of intracranial hemorrhage. Journal of stroke 2017; 19(1): 11-27.
  10. Rammos SK, Gardenghi B, Bortolotti C, Cloft HJ, Lanzino G. Aneurysms associated with brain arteriovenous malformations. AJNR Am J Neuroradiol 2016; 37(11): 1966-71.
  11. Nhat Huy LM, Cuong TC, Nhat Huy ND, Giang NL, Hung NQ, Dang NH, et al. Treatment of arteriovenous malformations associated with ruptured intracranial aneurysm. Biomed Res Ther 2023; 10(4): 5614-8.
  12. Hughes JD, Bond KM, Mekary RA, Dewan MC, Rattani A, Baticulon R, et al. Estimating the global incidence of aneurysmal subarachnoid hemorrhage: a systematic review for central nervous system vascular lesions and meta-analysis of ruptured aneurysms. World Neurosurg 2018; 115: 430-47.
  13. Stapf C, Labovitz DL, Sciacca RR, Mast H, Mohr JP, Sacco RL. Incidence of adult brain arteriovenous malformation hemorrhage in a prospective population-based stroke survey. Cerebrovasc Dis 2002; 13(1): 43-6.
  14. Mortazavi ZS, Zandifar A, Kim JD, Tierradentro-García LO, Shakarami M, Zamharir FD, et al. Re-Evaluating Risk Factors, Incidence, and Outcome of Aneurysmal and Non-Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2023; 175: e492-504.
  15. Claassen J, Bernardini GL, Kreiter K, Bates J, Du YE, Copeland D, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke 2001; 32(9): 2012-20.
  16. Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES, et al. Prediction of symptomatic vasospasmafter subarachnoid hemorrhage: the modified fisher scale. Neurosurgery 2006; 59(1): 21-7.
  17. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986; 65(4): 476-83.
  18. Jali R, Farahangiz S. Frequency of multiple intracranial aneurysm in the patients who underwent angiographic study of cerebral arteries [in Persian]. J Isfahan Med Sch 2006; 22(72): 20-3.
  19. Nekouei S, Samini F, Fareghy Naeini F. Evaluation of epidemiologic and angiographic findings of 100 patients with brain AVM in Imam Reza and Shahid Kamyab Hospitals [in Persian]. Iranian Journal of Otorhinolaryngology 2006; 17(42): 213-8.
  20. Piotin M, Ross IB, Weill A, Kothimbakam R, Moret J. Intracranial arterial aneurysms associated with arteriovenous malformations: endovascular treatment. Radiology 2001; 220(2): 506-13.
  21. D'Aliberti G, Talamonti G, Cenzato M, La Camera A, Debernardi A, Valvassori L, Mariangela P, Nichelatti M. Arterial and venous aneurysms associated with arteriovenous malformations. World Neurosurg 2015; 83(2): 188-96.
  22. Stapf C, Mohr JP, Pile-Spellman J, Sciacca RR, Hartmann A, Schumacher HC, et al. Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation. J Neurol Neurosurg Psychiatry 2002; 73(3): 294-8.
  23. Sheikh Azadi A, Gharahdaghi J. Survey of aneurismal subarachnoid hemorrhage in 26 cadavers referred to legal medicine center of Tehran (2005-2006) [In Persian]. ran J Forensic Med 2007; 12(4): 210-5.
Journal of Isfahan Medical School
Volume 43, Issue 803
3rd Week, April
March and April 2025
Pages 79-86

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History

  • Receive Date: 25 January 2025
  • Accept Date: 01 February 2025

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