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Medical HEALTH "> Medical Neurology and Psychiatry Summary of unruptured brain arteriovenous malformations should conservative treatment? the full text of this collection of reRecommended Suke Jiang [1] Gao Yan PLA 66393 army hospital, Yi County, Hebei 074200 [2], the Second Affiliated Hospital of Suzhou University, Department of Neurology, 215004, "International Journal of Cerebrovascular Diseases" 2007 15 No. 11 fast food prizes Report Summary: To With noninvasive imaging technology, unruptured cerebral arteriovenous malformations significantly increased the detection rate for these patients should be taken to conservative treatment, or active intervention, there are still big differences. Support the conservative treatment that did not rupture in patients with cerebral arteriovenous malformation of the natural risk of bleeding is relatively low, and any invasive treatment of the expected high risk of treatment-related complications; and advocate an active treatment that is not the natural breakdown of cerebral arteriovenous malformation hemorrhage The risk is not as low as imagined, active treatment did not significantly increase risk. This issue still present large-sample randomized controlled clinical trials to clarify. Number of pages: 4 Page Range :877-880 Key words: cerebral arteriovenous malformations treated subject classification: R743.4 [medicine, HEALTH "Neurology and Psychi Cerebrovascular Dis cerebral vascular malformations] Related Articles: Topics Re


lated References (27)
Condition analysis:
More sudden onset, often in physical activity or emotional fluctuations appear. If the AVM is located in the superficial parts of a common cause of subarachnoid hemorrhage (SAH); if the bleeding is located in the deep, can be caused by intracerebral hematoma or intraventricular hemorrhage. Patients can show as severe headache, vomiting, consciousness may have different degrees of change. caused by SAH may also occur when the neck stiffness and Kernig sign was positive. According to statistics, the bleeding as the first symptom accounted for 67.8% of all cases of AVM. bleeding can occur repeatedly, the most up to more than 10 times.
Suggestion:
If these symptoms in young patients, especially in spontaneous SAH or intracerebral hemorrhage, should first think of the possibility of this disease. If the course of the disease is accompanied by localized or generalized seizures should be considered even more of the disease. Typical AVM in CT examination that is: a focal plain high, low or low density areas such as mixed and irregular, mostly lumpish, a few points can be showed linear shadow, edge and more unclear. around the lesion can be limitations of brain atrophy appears, sometimes with mild mass effect, usually without cerebral edema, but may have enlarged ventricles or communicating hydrocephalus. bleeding from the AVM visible hematoma cavity or malacia. injection after the AVM according to agents that affect block for the group to strengthen, and sometimes tortuous blood vessels visible shadow can be seen around the feeding arteries and draining veins

The treatment of cerebral arteriovenous malformations to prevent bleeding, reduce or correct the "brain steal", to improve the blood supply of brain tissue, relieve nerve dysfunction, seizure control and improve patients lives. Current treatment options include conservative treatment, microsurgical resection, endovascular surgery and check stereotactic radiotherapy.
1. Conservative treatment for older, only the symptoms of epilepsy or major functional areas in the brain and deep brain lesions or lesions not suitable for surgery in extensive deep, should be treated conservatively. The main purpose of conservative treatment is to prevent or stop bleeding and rebleeding, seizure control and ease symptoms.
(1) to maintain normal patterns of life: to avoid strenuous exercise, mood swings and fatigue, maintaining smooth stool, high blood pressure due to lower blood pressure. Bleeding, should definitely stay in bed for 1 to 6 weeks.
(2) antiepileptic therapy: selection based on the type of epilepsy, antiepileptic drugs, long-standing regular medication to control seizures. And limitations of grand mal seizures may be the preferred phenytoin, phenobarbital or flutter meters ketone, psychomotor seizures optional phenytoin, carbamazepine, nitrazepam, sodium valproate, etc., absence seizures can choose a small B Hu amine, sodium valproate, clonazepam and so on. Complete control of seizures is usually in 2 to 3 years before considering gradually reduce the dosage.
(3) symptomatic treatment: a bleeding may be symptomatic treatment of subarachnoid hemorrhage. Who have increased intracranial pressure such as dehydration agent may be given mannitol reduce intracranial pressure. Such as large hematoma, increased intracranial pressure is serious, it is desirable that surgical removal of hematoma. Selected based on the patient's symptoms of symptomatic treatment of different drugs to reduce the patient's symptoms.
(4) to prevent further bleeding: You can try Aminomethylbenzoic acid, aminocaproic acid and other clotting drugs to prevent further bleeding, but its efficacy remains to be further confirmed.
2. Microsurgical resection of the application of microsurgical technique to the brain AVM surgical resection rate is greatly improved. So far, surgical resection is still the definitive treatment of this disease one of the best.


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