Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Quebec, Canada.
Med Hypotheses. 2011 Apr;76(4):570-3. doi: 10.1016/j.mehy.2011.01.003. Epub 2011 Feb 1.
While early rerupture of cerebral arteriovenous malformations (AVMs) may not be as rare as previously thought, its determinants and risk factors remain unknown. Impairment of the venous drainage of AVMs is a well known risk factor for rupture and has been linked with the development of perinidal cerebral edema. We propose that a significant proportion of early AVM reruptures are the result of post-hemorrhagic venous drainage impairment, which may manifest as refractory perihematomal edema. To support this hypothesis, an illustrative case of early AVM rerupture occurring 3 weeks following intracranial hemorrhage and heralded by progressive perinidal and perihematomal edema is presented. This finding should be viewed as a marker for unstable lesions with a high risk of imminent rerupture and should thus prompt a rapid definitive treatment for the AVM.
虽然脑动静脉畸形（AVM）的早期再破裂可能并不像以前认为的那么罕见，但它的决定因素和风险因素仍不清楚。AVM 的静脉引流受损是破裂的一个已知危险因素，并与瘤周脑水肿的发展有关。我们提出，相当一部分早期 AVM 再破裂是出血后静脉引流受损的结果，可能表现为难治性血肿周围水肿。为了支持这一假说，我们提出了一个说明性的病例，即颅内出血后 3 周发生的早期 AVM 再破裂，并伴有进行性瘤周和血肿周围水肿。这一发现应被视为不稳定病变的标志物，具有即将再破裂的高风险，因此应迅速对 AVM 进行确定性治疗。
