Intracranial vascular malformation

Reduction of admissions for hemorrhagic cerebrovascular disease due to vascular malformations during the COVID-19 lockdown was not confirmed. Nevertheless, some patients reached the emergency rooms only several days after symptoms onset, resulting in a worse clinical condition at admission 1)

Intracranial vascular malformations (brain or pial/dural arteriovenous malformations/fistulae, and aneurysms) are the leading cause of intracerebral hemorrhage (ICH) in young adults. Early identification of the intracranial vascular malformation may improve outcomes if treatment can prevent ICH recurrence. Catheter intra-arterial digital subtraction angiography (IADSA) is considered the reference standard for the detection an intracranial vascular malformation as the cause of ICH. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are less invasive than IADSA and may be as accurate for identifying some causes of ICH.

CTA and MRA appear to have good sensitivity and specificity following ICH for the detection of intracranial vascular malformations, although several of the included studies had methodological shortcomings (retrospective designs and partial verification bias in particular) that may have increased apparent test accuracy 2).

De Bonis P, Cavallo MA, Sturiale CL, Martellucci C, Flacco ME, Dughiero M, Auricchio AM, Ricciardi L, Raco A, Bortolotti C, Tosatto L, D'Andrea M, Ruggiero M, Mongardi L, Zona G, Fiaschi P, Cofano F, Garbossa D, Scerrati A. Incidence of hemorrhagic cerebrovascular disease due to vascular malformations during the COVID-19 national quarantine in Italy. Clin Neurol Neurosurg. 2021 Jan 19;202:106503. doi: 10.1016/j.clineuro.2021.106503. Epub ahead of print. PMID: 33493878.
Josephson CB, White PM, Krishan A, Al-Shahi Salman R. Computed tomography angiography or magnetic resonance angiography for detection of intracranial vascular malformations in patients with Intracerebral hemorrhage. Cochrane Database Syst Rev. 2014 Sep 1;9:CD009372. [Epub ahead of print] PubMed PMID: 25177839.
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