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Abstract: The etiology of cerebral arteriovenous malformation is unknown and may be related to genetic and other factors, belonging to a vascular anomaly. The patient in this article had occasional headache symptoms, often aggravated by emotional excitement and strenuous activity, and no other uncomfortable symptoms, and was previously in relatively good health. After coming to our hospital, through active interventional treatment, the patient’s condition was basically controlled and the headache symptoms disappeared, and a good prognosis was achieved.
Basic information】Male, 27 years old
Type of disease】Brain arteriovenous malformation
Hospital】The First Affiliated Hospital of Zhengzhou University
Time of consultation】November 2019
Treatment plan】Interventional treatment (middle cerebral artery interventional embolization)
【Treatment period】7 days of hospitalization in phase I. Phase II embolization was given 2 months after surgery
Treatment effect] The disease was basically controlled, and there were no obvious discomfort symptoms
I. Initial consultation
The patient, a 27-year-old boy, did not observe any obvious discomfort when he came to our hospital. He reported that he was an office clerk and was usually in good health, with occasional headache symptoms, which might be aggravated by emotional and physical activities at work. He was told through a physical examination that he had a cerebral arteriovenous malformation, and after asking people around him that the blood vessel was prone to rupture and bleeding, he wanted to seek further treatment and came to our hospital. The arteriovenous malformation of the brain is a critical disease, and if it is not treated in time, it is more dangerous to the body.
II. Treatment process
After the patient was admitted to the hospital, we immediately performed a series of examinations on the patient and gave him an MRI examination, which showed a left frontal arteriovenous malformation and a cerebral angiogram showing a malformed brain arteriovenous configuration. Also, the patient had a grade 2 arteriovenous malformation embolism and the lesion was located in the motor function area.
Due to the young age of the patient, it was decided to avoid open surgery and to give embolization of the middle cerebral artery instead. The embolization of the brain was divided into two phases. The first phase of treatment was to address the middle cerebral artery malformation mass, and the area supplied by the cerebral arteriovenous malformation mass was treated with glue to reduce the size of the malformation mass and preserve part of the anterior cerebellar artery malformation mass, which was a smooth procedure. Seven days after the operation, the patient was discharged from the hospital to recuperate, and was instructed to come back to the hospital in 2 months for phase II embolization treatment, in which two branches of the anterior cerebral artery were chosen to be glued separately to achieve the effect that the malformed mass was not visible.
III. Treatment effect
After stage I cerebral artery embolization treatment, the patient could feel relief of symptoms, headache symptoms were reduced, and there were no other uncomfortable symptoms. After stage II embolization treatment, there was no discomfort and headache symptoms were significantly relieved, but occasional mild headache symptoms were often normal and did not affect consciousness, physical activity, diet, sleep and so on. The results of the brain angiography, which was repeated 3 months after the operation, showed that the brain arteriovenous malformation construct disappeared and the patient’s headache symptoms completely disappeared.
IV. Notes
We are glad that after a series of treatments, the patient’s condition was controlled without open surgery and the headache symptoms completely disappeared. However, due to the large risk of the disease and to prevent recurrence, the patient still needs to pay attention to the following conditions in daily life.
1. patients need to be regularly reviewed under the guidance of their doctors 3 or 6 months after discharge from the hospital to observe the presence of uncomfortable symptoms.
2.Since headache symptoms are often aggravated by mood swings and increased physical activity, patients need to avoid mood swings and heavy physical activity during treatment, ensure adequate rest and relaxation.
3. Patients need to pay attention to a balanced and regular diet in their daily life, and try to choose light, easily digestible and highly nutritious food, such as noodles, lean meat, eggs, etc.
4.If the headache worsens or if the consciousness or activity is impaired, the patient needs to actively go to the hospital for consultation.
V. Personal insight
For patients with cerebral arteriovenous malformation, which is a congenital disease but often develops around the age of 20, patients may have prolonged headache, epilepsy or even brain hemorrhage symptoms, which may manifest as loss of consciousness or even death in the event of brain hemorrhage, and is therefore more critical. If a patient has a prolonged headache, he or she should pay attention to it and go to the hospital in time. If not treated in time, there may be sequelae, such as hemiplegia and aphasia. In the case of this patient, it was fortunate that he was detected in time through physical examination and was treated in time, so that he had a good prognosis without open surgery and did not suffer from serious conditions that might otherwise have affected his life in the future.