How do brain vascular malformations impact neurological health. What are the key characteristics of arteriovenous malformations and cavernomas. How can immunohistochemistry and ultrastructural analysis enhance our understanding of these lesions.

Understanding Brain Vascular Malformations: Types and Prevalence

Brain vascular malformations are abnormal formations of blood vessels in the brain that can significantly impact neurological health. These lesions are relatively common and can lead to severe neurological disabilities or even death in many affected individuals. To better understand these conditions, researchers conducted a comprehensive study analyzing 50 cases of brain vascular lesions.

The study revealed two primary types of brain vascular malformations:

• Arteriovenous malformations (AVMs): 29 cases (58%)
• Brain cavernomas: 21 cases (42%)

These findings highlight the prevalence of AVMs among brain vascular malformations, accounting for more than half of the cases studied.

Demographic and Clinical Characteristics of Brain Vascular Lesions

Understanding the demographic and clinical features of brain vascular lesions is crucial for improved diagnosis and treatment. The study provided valuable insights into these aspects:

Gender Distribution

The gender distribution of patients with brain vascular lesions was relatively balanced:

• Female patients: 26 (52%)
• Male patients: 24 (48%)

This suggests that brain vascular malformations affect both genders almost equally, with a slight predominance in females.

Age Range and Mean Age

The age of patients with brain vascular lesions varied significantly:

• Youngest patient: 13 years old
• Oldest patient: 68 years old
• Mean age: 35.86 ± 15.19 years

This wide age range indicates that brain vascular malformations can affect individuals across different life stages, from adolescence to late adulthood.

Lesion Size and Location

The size of brain vascular lesions varied considerably:

• Smallest lesion: 1 cm
• Largest lesion: 8 cm
• Average size: 3 ± 1.65 cm

Interestingly, parieto-occipital lesions tended to be larger in size. This information can be valuable for surgical planning and predicting potential complications.

Evolution Time

The evolution time of brain vascular lesions, which refers to the period from initial symptoms to diagnosis or treatment, ranged from 1 month to 1 year, with an average of 7.5 months. This highlights the variability in disease progression and the importance of early detection and intervention.

Clinical Manifestations and Complications of Brain Vascular Lesions

Brain vascular malformations can present with various clinical manifestations and complications. The study identified several significant correlations between patient characteristics and clinical outcomes:

• Age and sex were statistically correlated with lesion rupture (P = 0.015)
• Brain hemorrhage showed a significant correlation (P = 0.033)
• Necrosis was associated with certain patient characteristics (P = 0.011)
• Hemosiderin deposits, indicative of past bleeding, were correlated with specific factors (P = 0.042)
• Loss of consciousness was significantly associated with certain features (P = 0.000)
• Visual deficits were correlated with specific characteristics (P = 0.026)

These correlations provide valuable insights into the potential risk factors and clinical outcomes associated with brain vascular lesions, which can aid in patient management and prognosis determination.

Immunohistochemical Analysis of Brain Vascular Lesions

Immunohistochemistry plays a crucial role in understanding the molecular characteristics of brain vascular lesions. The study examined the expression of various antibodies in these lesions:

• CD31
• CD34
• CD15
• Factor VIII
• Nestin
• Vimentin
• Vascular Endothelial Growth Factor (VEGF)
• Vascular Endothelial Growth Factor Receptor-2 (VEGF-R2)
• Glial Fibrillary Acidic Protein (GFAP)
• Fibroblast Growth Factor β (β-FGF)

The analysis revealed significant correlations between certain antibodies and clinical features:

• VEGF expression was correlated with specific patient characteristics (P = 0.015)
• VEGFR expression showed a significant association (P = 0.037)
• CD31 expression was correlated with certain features (P = 0.009)

These findings provide valuable insights into the molecular mechanisms underlying brain vascular lesions and may contribute to the development of targeted therapies.

Ultrastructural Analysis of Brain Vascular Lesions

Ultrastructural analysis using electron microscopy offers a detailed view of the cellular and subcellular components of brain vascular lesions. The study examined the ultrastructure of endothelial cells and vessel walls in these lesions.

Key observations from the ultrastructural analysis included:

• Abnormal endothelial cell morphology
• Alterations in vessel wall structure
• Presence of hyaline vessels, which showed a significant correlation with certain features (P = 0.000)

These ultrastructural findings provide valuable information about the structural abnormalities present in brain vascular lesions, which can contribute to a better understanding of their pathophysiology and potential treatment targets.

Implications for Diagnosis and Treatment of Brain Vascular Lesions

The comprehensive analysis of brain vascular lesions presented in this study has several important implications for diagnosis and treatment:

Enhanced Diagnostic Accuracy

The combination of clinical, pathological, and molecular features can improve the accuracy of diagnosing brain vascular malformations. This multi-faceted approach allows for a more precise characterization of lesions, which can guide treatment decisions.

Personalized Treatment Strategies

Understanding the specific molecular and ultrastructural characteristics of individual lesions can pave the way for personalized treatment strategies. For example, targeting specific growth factors or receptors identified through immunohistochemistry may lead to more effective therapies.

Risk Assessment and Prognosis

The correlations identified between patient characteristics, clinical features, and molecular markers can help in assessing the risk of complications and predicting prognosis. This information can be valuable for patient counseling and management.

Development of Novel Therapies

The insights gained from this comprehensive analysis may contribute to the development of novel therapies targeting specific molecular pathways or structural abnormalities identified in brain vascular lesions.

Future Directions in Brain Vascular Lesion Research

While this study provides valuable insights into brain vascular lesions, several areas warrant further investigation:

Longitudinal Studies

Conducting longitudinal studies to track the progression of brain vascular lesions over time could provide valuable information about their natural history and factors influencing their growth or regression.

Genetic Analysis

Incorporating genetic analysis into future studies could help identify potential genetic factors contributing to the development and progression of brain vascular malformations.

Advanced Imaging Techniques

Exploring the use of advanced imaging techniques, such as functional MRI or molecular imaging, could provide additional insights into the functional and molecular characteristics of brain vascular lesions in vivo.

Therapeutic Trials

Conducting clinical trials targeting specific molecular pathways identified in this study could lead to the development of more effective treatments for brain vascular malformations.

Comparative Studies

Comparing the characteristics of brain vascular lesions across different populations and geographic regions could help identify potential environmental or genetic factors influencing their development and progression.

In conclusion, this comprehensive analysis of brain vascular lesions provides valuable insights into their clinical, pathological, and molecular characteristics. By integrating multiple approaches, including immunohistochemistry and ultrastructural analysis, the study enhances our understanding of these complex lesions and opens new avenues for improved diagnosis and treatment. As research in this field continues to advance, it holds promise for better outcomes for patients affected by brain vascular malformations.

Brain vascular lesions: a clinicopathologic, immunohistochemistry, and ultrastructural approach

. 2014 Aug;18(4):193-8.

doi: 10.1016/j.anndiagpath.2014.01.005.

Epub 2014 Feb 25.

Marisol Galván Navarrete 
¹
, Alma Dalia Hernández 
²
, Miguel Angel Collado-Ortiz 
³
, Citlaltepetl Salinas-Lara 
⁴
, Martha Lilia Tena-Suck 
⁵

Affiliations

Affiliations

• ¹ General Hospital of Guadalajara Hospital civil antiguo de Guadalajara Jalisco, Guadalajara, Mexico.
• ² Laboratory of Pathology, National Institute of Rehabilitation, México City, Mexico.
• ³ Neurological Center, Department of Clinical Neurophysiology, The American British Cowdray Hospital, Mexico City, Mexico. Electronic address: [email protected].
• ⁴ Department of Neuropathology, National Institute of Neurology and Neurosurgery, México City, Mexico. Electronic address: [email protected].
• ⁵ Department of Neuropathology, National Institute of Neurology and Neurosurgery, México City, Mexico. Electronic address: [email protected].

• PMID:

  24881784

• DOI:

  10.1016/j.anndiagpath.2014.01.005

Marisol Galván Navarrete et al.

Ann Diagn Pathol.

2014 Aug.

. 2014 Aug;18(4):193-8.

doi: 10.1016/j.anndiagpath.2014.01.005.

Epub 2014 Feb 25.

Authors

Marisol Galván Navarrete 
¹
, Alma Dalia Hernández 
²
, Miguel Angel Collado-Ortiz 
³
, Citlaltepetl Salinas-Lara 
⁴
, Martha Lilia Tena-Suck 
⁵

Affiliations

• ¹ General Hospital of Guadalajara Hospital civil antiguo de Guadalajara Jalisco, Guadalajara, Mexico.
• ² Laboratory of Pathology, National Institute of Rehabilitation, México City, Mexico.
• ³ Neurological Center, Department of Clinical Neurophysiology, The American British Cowdray Hospital, Mexico City, Mexico. Electronic address: [email protected].
• ⁴ Department of Neuropathology, National Institute of Neurology and Neurosurgery, México City, Mexico. Electronic address: [email protected].
• ⁵ Department of Neuropathology, National Institute of Neurology and Neurosurgery, México City, Mexico. Electronic address: [email protected].

• PMID:

  24881784

• DOI:

  10.1016/j.anndiagpath.2014.01.005

Abstract

Brain vascular malformations are relatively common lesions that cause serious neurologic disability or death in a significant proportion of individuals bearing them. The purpose of this study was to analyze the clinicopathologic and immunohistochemistry these lesions, looking for common antibodies expressed such as CD31, CD34, CD15, factor VIII, nestin, vimentin, vascular endothelial grow factor (VEGF), vascular endothelial grow factor receptor-2 (VEGF-R2), glial fibrillar acidic protien (GFAP), and fibroblastic grow factor β (β-FGF) and ultrastructure in endothelial cells as well as in vessel walls. Fifty cases of vascular lesions were included in this study: 29 (58%) of them were arteriovenous malformations and 21 (52%) were brain cavernomas. Twenty-six (52%) patients were women and 24 (48%) men. The age range was from 13 to 68 years (mean age, 35.86 ± 15.19 years). The size of the lesions ranged between 1 and 8 cm (3 ± 1.65 cm), and parieto-occipital lesions had a bigger size. Evolution time varied from 1 month to 1 year (mean, 7.5 months). There was a significant statistical correlation between age and sex (P = -035), rupture of lesion (P = .015), brain hemorrhage (P = . 033), necrosis (P = .011), hemosiderin deposit (P = .042), VEGF (P = .015), and VEGFR (P = .037), as well as localization of rupture (P = .017), loss of consciousness (P = .000), visual deficit (P = .026), hyaline vessels (P = .000), and CD31 (.009). Interactions between endothelial cells and mural cells (pericytes and vascular smooth muscle cells) in blood vessel walls have recently come into focus as central processes in the regulation of vascular formation, stabilization, remodeling, and function in brain vascular lesions. However, the molecular mechanisms that underlie the formation and growth of brain arteriovenous malformations are still poorly understood.

Keywords:

Arteriovenous malformation; Cerebral cavernoma; Cerebral vessels; Immunohistochemistry; Ultrastructure.

Copyright © 2014 Elsevier Inc. All rights reserved.

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Vascular Malformations of the Brain | Peter O’Donnell Jr.

Brain Institute | Condition

UT Southwestern
Medical Center’s highly experienced cerebrovascular team provides accurate
evaluation and the latest treatments for brain vascular malformations. Patients
come from across the country to benefit from our expertise.

Our multidisciplinary
team – from surgeons to neuroanesthesiologists to nurses – all specialize in
treating patients with brain disorders.

Expert Care for Brain Vascular Malformations

Vascular
malformations of the brain occur when the brain’s blood vessels develop
abnormally, a condition that is usually congenital (present at birth). The
condition includes abnormalities with veins and arteries that alter the normal
flow of blood in the brain.

The most common types
of vascular malformations are:

• Arteriovenous malformations (AVMs): The development of abnormal
  arteries and veins that bypass the normal capillary system in the brain
• Cavernomas (also known as cavernous malformations):
  A cluster of abnormal, enlarged blood vessels that resembles dilated veins
• Dural arteriovenous fistula (DAVF): A type of AVM that involves a
  direct connection between arteries and veins but without a nest of abnormal
  vessels (or nidus) like AVMs
• Venous angiomas: Enlarged veins that drain a normal
  segment of the brain

As a major referral
center for brain and spine disorders, UT Southwestern’s brain vascular
malformations team offers a broad range of capabilities, including minimally
invasive brain surgery treatments. One of our hallmarks is providing patients
with a range of options, tailored to their circumstances.

Every neurosurgeon on
our brain vascular malformations team has specialized fellowship training in
the management of cerebrovascular disorders. Many of our physicians have dual
training in both neurosurgery and radiology. This means the expert who
evaluates these disorders is also the surgeon who will perform interventional
treatment such as open surgery, endovascular embolization, or stereotactic
radiosurgery. 

Whether a patient is
seeking a diagnosis or a treatment plan, it’s our goal to see each person
as quickly as possible, often the same day an appointment is requested, and
provide an evaluation of the situation before the patient leaves that day.

Symptoms of Brain Vascular
Malformations

Symptoms of brain vascular
malformations depend on the type, size, and location of the malformation. In many cases, symptoms can take years to show up, even though the malformation might have been
present at birth. In other cases, there are no symptoms at all.

When symptoms do
appear, they range from chronic headaches to
seizures. The most serious
complication is a stroke.

Our Services

Every one of our
cerebrovascular specialists reviews a patient’s case before any treatment
begins, and we work closely with our colleagues in neurology, radiology, neurosurgery,
and neurointensive care to make sure we offer the right solution for each
patient. Our collaboration is facilitated by a weekly cerebrovascular conference
that provides multiple and sometimes diverse opinions to the patient. Learn more about evaluations for brain vascular
malformations.

Treatment might include
the following:

• Observation
• Endovascular
  embolization
• Open surgery
• Stereotactic
  radiosurgery

After initial
treatment, we offer a dedicated neurointensive care unit (neuro ICU) for patients
with brain disorders, as well as neurorehabilitation services, all in the same
building.  Learn more about treatments for brain vascular
malformations.

See More

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7th Floor

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214-645-2300

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How to treat cerebral vessels and how to

• Home
• Blog
• Cerebral vascular diseases

Content:

• What are cerebrovascular diseases

• Causes of cerebrovascular disease

• Features

• Who treats cerebral vessels, which doctor

• Which drugs treat cerebral vessels

• Prophylaxis and surgery

According to statistics, more than 75% of the population is predisposed to vascular diseases. The problem is that such diseases are latent for a long time, do not cause a clear clinical picture. Let’s talk about how to treat the vessels of the brain, what methods and drugs.

What are cerebrovascular diseases

CNS diseases can significantly affect performance, lead to disability, and in 10-20% of cases – to death.

Main pathologies:

• Ischemia. Developing for a long time, it can cause ischemic stroke. A number of patients do not fully recover, and a lethal outcome is not ruled out.
• Aneurysms. Diagnosed 3 times less often than chronic ischemia, but the degree of danger is not inferior to stroke.
• Hemorrhagic stroke with hemorrhage.
• Hematomas due to traumatic injury.
• Anomalies of connective tissue.
• Dyscirculatory encephalopathy (micro strokes).

There are also less common diseases that cannot be recognized on their own. Almost every adult is at risk, either due to a hereditary factor, or due to lifestyle characteristics and acquired diseases.

Causes of cerebrovascular disease

In the vast majority of cases, the cause of the disease is the deposition of plaques on the walls of blood vessels. It must be understood that the deposition of cholesterol begins at an early age and continues throughout life. Nevertheless, many patients bypass the question of blood tests for the presence of cholesterol. Another common cause is hypertension. Vascular damage is also observed in diabetes mellitus.

Risk factors:

• CNS toxicity, including prenatal period.
• Blood clotting.
• Constant release of adrenaline and other stress hormones.
• High LDL.
• Thinning of the walls due to high pressure in the vessels.
• Destruction of cells due to exposure to ethanol.
• Low physical activity, lack of pressure on blood vessels.
• Tobacco smoking.
• Overweight.

Vessels can suffer due to completely different reasons. Some factors can be influenced (for example, give up bad habits), other factors are non-modifiable (such as heredity).

Signs

As already noted, it is difficult to identify vascular disorders by symptoms. Critical conditions such as stroke or aneurysm rupture cause more pronounced symptoms with headache and loss of consciousness. But still, it is worth trying to recognize the pathology, at least in order to be able to seek medical help in time.

Symptoms of chronic deterioration of the blood supply to the brain:

• Fatigue that occurs after a short period.
• Frequent nausea.
• Aggressiveness.
• Sudden weight loss.
• Decreased concentration.
• Depressive conditions.
• Sleep disorders.
• Violation of attention, distraction, forgetfulness.
• Ringing in the ears.
• Violation of diction.
• Weakness in the arms.
• Pain in the cervical region.
• Convulsive syndrome.
• Vertigo.
• Headaches.

Against the background of a prolonged deterioration in blood supply, an ischemic stroke develops. The danger of this condition is that up to 80% of patients cannot return to the lifestyle that they led before the brain infarction. Due to circulatory disorders, some important functions may be lost, a person becomes dependent on others, cannot work, fully serve himself.

Signs of ischemic stroke:

• Gradual increase in symptoms.
• Violation of the heart rhythm.
• Distortion of the face.
• Slurred speech, as if intoxicated.
• Visual impairment.
• Violation of muscle tone, due to which the patient cannot raise his arms synchronously.
• Often – the absence of headaches.

Signs of hemorrhage:

• Abrupt onset.
• Reaction to light.
• Nausea.
• Severe headache.
• Soreness of the eyes.
• Increased blood pressure.

The brain is not an organ that needs to be treated on its own. If you have problems, make an appointment with a therapist or specialist.

Who treats cerebral vessels, which doctor

If you notice disturbing symptoms, make an appointment with a neurologist. The doctor will prescribe treatment after a comprehensive diagnosis, which may include the following procedures:

• Laboratory tests.
• Computed tomography.
• ECG and ECHO-KG (to detect the relationship between CVD and cerebrovascular disease).
• CT angiography – study of blood vessels with the introduction of a contrast agent.
• MRI.
• Ultrasonic diagnostics of cerebral and cervical vessels.

How to treat the vessels of the brain, in each case, doctors determine individually, taking into account the diagnosis, severity of the case, concomitant diseases in the patient.

Which drugs treat cerebral vessels

Self-treatment is unacceptable in case of vascular disorders. It is impossible to independently select not only medicines, but also dietary supplements: incorrect therapy can be harmful.

Which drugs can be prescribed by a neurologist:

• Neuroprotectors. They improve brain function, protect against damaging effects, and are able to prevent cell death.
• Anticoagulants. They are used to thin the blood and fight blood clots.
• Glucocorticoids. They are used to improve hemodynamic parameters, improve venous outflow, and normalize hormonal levels.
• Antiaggregants. Prevent thrombosis.
• Antioxidants. Inhibit oxidants.

Combination therapy with blood counts is most commonly given twice a month. Patients on anticoagulant therapy should report any episodes of bleeding to their physician. For movement disorders, exercises are prescribed, for memory lapses – drugs to speed up metabolic processes, for depression – psychotherapy.

What herbs treat cerebral vessels:

• Ginkgo biloba. The extract is claimed to be effective in high blood pressure, relieve tinnitus, help recover faster from a stroke, help with cognitive impairment, but evidence of effectiveness has not been presented. It should be borne in mind that the supplement increases the risk of bleeding, therefore it is prohibited for hemorrhagic stroke. May cause gastrointestinal problems, heart palpitations, nausea. With the simultaneous use of antiplatelet drugs and dietary supplements, the latter affects the dosages used.
• Aralia. In case of an overdose, it causes bleeding, fainting, and respiratory failure.
• Ginseng. Not used for bleeding, fever, sleep deprivation, contraindicated in patients with diabetes.

Thus, drugs with unproven efficacy are generally not recommended for use in any disease, especially when it comes to the central nervous system. It is better to start treatment immediately with proven medicines than to repair the damage caused by herbal remedies.

Prevention and surgery

Not every condition can be predicted, but to reduce the risk of vascular diseases, one should limit the intake of salt, unhealthy fats, gradually reduce weight, take vitamins as prescribed, move more.

When the vessel is blocked by more than 70%, the question arises of the use of surgical endovascular techniques. Patients may be prescribed angioplasty and stenting, during which the lumen of the vessel expands, and the affected walls are supported by a special design – a stent. If the technique is ineffective in a particular medical case, they resort to reconstruction of the vascular bed using shunting.

If you suspect vascular disease, sign up for a consultation and examination at the Chekhov Vascular Center in the Moscow Region. We carefully approach each problem, select effective treatment strategies and prescribe surgery according to indications. You can contact us 24 hours a day, any day of the week. 142301

This email address is being protected from spambots. You must have JavaScript enabled to view.

Mon-Sun – 24 hours

Vascular diseases of the brain | Clinic Rassvet

According to epidemiological data, more than 40% of the world’s population has high blood pressure, almost 10% suffer from diabetes. It is these diseases that are the main risk factors for the development of not only heart pathologies, but also cerebrovascular diseases.

How vascular lesions affect the brain

Maintaining a constant level of cerebral blood flow is essential for the full functioning of the brain. That is why this organ has a fairly intensive blood supply. Blood enters the brain through four main vessels passing through the neck: two carotid and two vertebral arteries. They connect at the base of the brain, forming the so-called circle of Willis. From it, many smaller vessels diverge to different parts of the brain. This is a defense mechanism in case a catastrophe occurs in one of the four main vessels. The problem is that vascular diseases also affect smaller vessels that supply blood to distant parts of the brain and do not have collaterals (lateral or bypass blood flow) and compensatory mechanisms.

Diseases associated with impaired cerebral circulation

Acute or chronic damage to cerebral vessels leads to numerous cerebrovascular diseases.

Acute cerebrovascular accidents (ACC) include various types of strokes (ischemic or hemorrhagic), transient ischemic attacks and subarachnoid hemorrhages. With ischemic types of stroke (ischemic stroke or transient ischemic attack), there is a sharp obstruction to blood flow through the vessels, for example, a thrombus or an atherosclerotic plaque. As a result, a certain part of the brain is in conditions of oxygen deficiency, and neurons begin to die. If during a transient ischemic attack the obstruction to blood flow regresses quickly enough, then during an ischemic stroke it remains, and a cerebral infarction is formed.

Hemorrhagic circulatory disorders occur as a result of a violation of the integrity of the vessels of the brain, which is manifested by a hemorrhage into the substance of the brain (hemorrhagic stroke) or into the space between the brain and its membranes (subarachnoid hemorrhage).

The problem of stroke is colossal! Stroke kills at least 400 people every day around the world, that is, every 3. 7 minutes someone dies from a stroke.

Chronic cerebrovascular accident is a no less dangerous condition. It is believed that more than 35 million people with dementia live in the world today. More than 40% of cases of this disease are caused precisely by chronic disorders of cerebral circulation or their combination with Alzheimer’s disease. It should be said that this condition has nothing to do with “osteochondrosis of the cervical spine” and “pinched muscles in the neck.” Recently, a more precise term has been used – small vessel disease of the brain. This condition is characterized by a change in the structure of vessels of small diameter against the background, for example, of high blood pressure and, consequently, a prolonged inadequate supply of blood to the brain. Clinically, such conditions are characterized mainly by cognitive impairment, up to the development of vascular dementia, as well as impaired gait, speech, and urination.

Features of the treatment of cerebrovascular diseases

Today, there is practically no treatment for circulatory disorders that have already occurred, with the exception of thrombosis and thromboextraction in acute ischemic stroke. Widely used popular “neurometabolic” and “vascular” drugs have not been shown to be effective in any of the studies, in any type of cerebrovascular accident.

The main approach is to identify individual patient risk factors and manage them.

The only way to prevent subsequent circulatory disorders is to accurately determine the cause of what has already happened and correct it.
The only effective method of dealing with the consequences of cerebrovascular accidents that have already occurred is timely (early) and full-fledged rehabilitation of patients.

How cerebrovascular diseases are treated at the Rassvet Clinic

Doctors at the Rassvet Clinic have extensive experience in working with patients who suffer from chronic circulatory disorders or have had an acute stroke. We will determine the type of circulatory disorder, identify risk factors for cerebrovascular diseases and develop an individual program for the prevention of vascular events.