Intracranial Arteriovenous Fistulas Research Articles

Congestive heart failure secondary to cerebral arteriovenous aneurysm in the newborn infant.

IT HAS been well established that the commonest cause of congestive heart failure in the neonatal period is congenital heart disease. Nevertheless other causes exist, and may in fact require a different approach to both diagnosis and therapy. Hemodynamically any arteriovenous malformation can lead to congestive failure if there is a sufficiently large ateriovenous shunt through a fistulous channel or channels. When the malformation is intracranial the predominant signs and symptoms have, however, usually been neurological,1,2thereby drawing attention to the site of the lesion. Prior to 1955 there is little mention in the literature of the association between intracranial arteriovenous fistulas and congestive heart failure in the newborn infant. In the ten-year period 1955 to 1965 there have been 14 cases reported of cerebral arteriovenous aneurysms presenting as congestive heart failure either as the sole or major manifestation of the lesion in the first week of life (Table).

Early venous filling in cranial angiography.

Early venous filling in cerebral angiography is usually indicative of a primary or secondary neoplasm of the brain. Arteriovenous malformations, accounting for 4 per cent of all brain lesions (1) are a less common cause. With the advent of routine serial angiography, unusual causes of rapid venous filling have been seen. During the past several years we have observed 47 cases of arteriovenous shunting (early venous filling) not due to a primary or secondary intracerebral neoplasm or an arteriovenous malformation (Table I). Our experience with these disease processes is the subject of this report. Early venous filling is said to be present when there is progression from the arterial filling phase to the venous phase without an obvious or apparent intervening arterial emptying or capillary phase. Local or diffuse decrease in circulation time with an orderly progression of the arterial-venous phase also represents early venous filling. Only in this latter situation have we not used the term arteriovenous shunting interchangeably with early venous filling. Except in one case (meningitis) in which there was diffuse arteriovenous shunting, early venous filling was restricted to the local area of pathology. In this communication each general cause of this vascular phenomenon is discussed individually. I. Arteriovenous Fistula Of the 18 arteriovenous fistulas seen, 12 were carotid artery-cavernous sinus (Fig. 1), 4 carotid artery-jugular vein (Fig. 2), one superficial temporal artery-vein, and one vertebral artery-vein. All cases were post-traumatic. Arteriovenous fistula implies communication between the arterial and venous systems without an intervening arteriolar-capillary network. The first two recognized cases of arteriovenous fistulas were reported by W. Hunter in 1762 as post-phlebotomy complications of the arm (2). Most intracranial arteriovenous fistulas are post-traumatic in nature. The common site of involvement is the carotid artery-cavernous sinus level secondary to fracture at the base of the skull. In Locke's series of 544 cases of carotid cavernous fistula, 76.8 per cent were traumatic and 23.29 per cent were spontaneous (3). Spontaneous fistulas may arise from carotid cavernous aneurysms that rupture into the cavernous sinus. The exact site of origin of these aneurysms is variable as there are many branches of the cavernous carotid artery. A detailed anatomy of these vessels may be found in the papers by Parkinson (4, 5). Bilateral carotid-cavernous fistulas, although extremely rare, have been reported (6). Extracranial arteriovenous fistulas involving the carotid artery and jugular vein are usually secondary to trauma during manipulation for carotid artery puncture or secondary to a penetrating wound. Intentional carotid-jugular fistulas have been established in the past in an attempt to revascularize the brain via a retrograde route (7).

Cyanosis Caused by Methemalbuminemia

The diagnoses most frequently to be considered when a newborn infant is found to have heart failure and cyanosis include congenital lesions of the heart shunting unoxygenated blood to the systemic circuit. Less frequently seen are primarily acyanotic lesions that cause cyanosis by virtue of the left heart failure they engender. 1 The recent literature contains several case reports of infants whose failure was due to large intracranial arteriovenous fistulae, but these were acyanotic until severe left heart failure developed. 2-12 We have recently observed a newborn boy with heart failure caused by an intracranial arteriovenous fistula, but who had cyanosis when he was in only moderate failure. Investigations revealed methemalbumin discoloring his plasma, and bilateral subdural hematomas. As the chocolate-colored fluid was removed from the subdural spaces, both his cyanosis and the plasma pigment cleared, without a significant change in his cardiac status. Report of Case A Caucasian boy

Visualization of an Intracranial Arteriovenous Fistula during Angiocardiography in an Infant with Congestive Heart Failure

Congestive heart failure in infants resulting from congenital intracranial arteriovenous fistulas is infrequent. The case reported here is believed to be the first one in which an angiocardiogram done for the identification of a possible congenital cardiac malformation incidentally disclosed the vascular anomaly in the posterior cranial fossa because the lower half of the skull happened to be included in the radiographic field. Case Report J. E. S., an 11 week-old girl, had been delivered spontaneously. Her birth weight was 6 pounds 2 ounces. For the first six weeks of life she was apparently normal. She then became restless, dyspneic and cyanotic. A grade II systolic murmur was present, the liver was moderately enlarged, and peripheral edema was noted over the lower extremities. Radiographic examination of the chest disclosed diffuse cardiac enlargement. It is of interest that one of the nurses had noted a humming sound when her ear was held close to the patient's head. On angiocardiographic examination ...

Congenital intradural arteriovenous fistula and congestive heart failure in infancy

A brief review is presented of intracranial arteriovenous fistulas with congestive heart failure and the salient features required to make a diagnosis of such a fistula. An 11-week-old infant is described with congestive heart failure secondary to a congenital intradural arteriovenous fistula. A systolic bruit was felt over the upper posterior neck and mastoid region, and an angiocardiogram revealed a collection of dye in the posterior cranial fossa suggestive of a venous angioma. The patient died before any corrective surgery could be considered. An intradural arteriovenous fistula was found in the posterior cranial fossa at postmortem examination.