Ozsarac Murat, Aksay Ersin, Kiyan Selahattin, Unek Orkun, Gulec F Feray
Department of Emergency Medicine, Ege University Hospital, Izmir, Turkey.
J Emerg Med. 2012 Jul;43(1):e17-20. doi: 10.1016/j.jemermed.2009.05.035. Epub 2009 Aug 13.
Arteriovenous malformations are shunts between an artery and the venous system that lie within a nidus without an intervening capillary bed. These lesions are thought to be congenital, but recent reports have challenged this assumption.
A 50-year-old man presented to the emergency department with a generalized tonic-clonic seizure. Before the onset of his seizure, he experienced a vivid auditory hallucination of his favorite song by the band Pink Floyd, "A Brick in the Wall." He had been diagnosed with epilepsy 25 years previously. On presentation, his neurological examination was normal, but a computed tomography scan of the brain revealed a large arteriovenous malformation (AVM) occupying the left temporal lobe. Upon more detailed questioning, he recalled that a brain angiogram had been performed 25 years before and was reported to be normal. Neurosurgery was not performed in view of the size of the malformation. The patient is being followed-up as an outpatient.
AVMs may arise de novo and then spontaneously become symptomatic. Cerebral de novo AVM should be considered in the differential diagnosis in patients with complex auditory musical hallucinations or any new neuropsychiatric symptoms.
动静脉畸形是动脉与静脉系统之间的分流，位于一个没有中间毛细血管床的病灶内。这些病变被认为是先天性的，但最近的报告对这一假设提出了质疑。
一名50岁男性因全身性强直阵挛发作被送往急诊科。在发作前，他经历了乐队平克·弗洛伊德（Pink Floyd）的他最喜欢的歌曲《墙上的一块砖》（A Brick in the Wall）的生动幻听。他在25年前被诊断为癫痫。就诊时，他的神经系统检查正常，但脑部计算机断层扫描显示左颞叶有一个大型动静脉畸形（AVM）。经过更详细的询问，他回忆起25年前曾进行过脑血管造影，报告显示正常。鉴于畸形的大小，未进行神经外科手术。该患者作为门诊病人正在接受随访。
AVM可能会新生，然后自发出现症状。对于有复杂听觉音乐幻觉或任何新的神经精神症状的患者，在鉴别诊断中应考虑脑新生AVM。
