1.What tests can confirm the diagnosis of cerebrovascular malformation?
(1) Cranial plain film, which shows the tortuous widening of middle meningeal artery, suggesting the possibility of malformed blood vessels.
(2) Head CT, which can detect hematoma and provide the possibility of malformed blood vessels.
(3) Magnetic resonance imaging of the head, which is superior to CT, can not only show the malformed vessels and their relationship with the surrounding brain tissue, but also distinguish between hemorrhage and calcification.
(4) Cerebral angiography is the most reliable and main diagnostic method for this disease, and it is the golden indicator for AVM diagnosis, and endovascular intervention can be performed during the examination.
2.How to determine the risk of rupture and bleeding of cerebrovascular malformation?
This determination is often based on the location and size of the vascular malformation and the relationship between the surrounding brain tissue. In general, malformations that are located in areas of major arterial supply and poor venous return, and that are large, are at higher risk of bleeding.
3.What is angiography? How is it done? Is it necessary to perform cerebral angiography?
Cerebral arteriogram: It is an examination in which contrast is introduced into the arterial system in the body and the alignment of the vessels is observed under x-ray for any abnormalities. It is usually performed under local anesthesia by introducing a guidewire into the femoral artery at the base of the thigh and injecting contrast.
To confirm the diagnosis of an arteriovenous malformation, it is best to have an angiogram, which is the most accurate test to truly reflect the abnormalities of the blood vessels. It is like a real-time map.
4.What are the typical signs of cerebral vascular malformation in angiography?
Cerebral arteriovenous malformation has the following typical manifestations.
(1) Showing malformed vessels. This is a characteristic manifestation of a mass of tortuous and dilated vessels of similar diameter and entangled with each other. The extent of the malformed vascular mass can be as small as a fingernail or as large as the palm of a hand, mostly in the cerebral hemisphere cortex.
(2) Abnormally large feeding arteries and draining veins with accelerated local circulation. This is a manifestation of local blood flow short circuit.
(3) Blood flow shunt phenomenon: the contrast agent flows into the vein with the blood flow through the short circuit of the malformed vessel, so that the malformed part of the vessel is very clearly visualized due to the increased blood flow.
(4) Performance of hematoma: The main manifestation of hematoma is local occupying sign when the blood vessel ruptures and bleeds to cause intracerebral hematoma, and when there is no hematoma in a brain arteriovenous malformation, there is no occupying sign in cerebral vessels and cerebral vessels are not displaced.
5.Is the patient prone to intolerance of contrast agent?
Contrast agents generally require allergy testing, and in general, allergies are rare. However, there are cases of allergy, so that the contrast examination cannot be done.
6.What is the difference between smog and cerebrovascular malformation?
Smoker’s disease is a compensatory proliferation of intracranial blood vessels caused by undeveloped blood vessels, which form like smoke. Vascular malformation is the result of abnormal development of the blood vessels themselves. They are fundamentally different, and I will write more about this in the future, specifically for smog.