Summary
Definition
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- deficit neurológico focal de início súbito
- convulsões
- rebaixamento do nível de consciência
Outros fatores diagnósticos
- cefaleia de início súbito
- náuseas
- vômitos
- confusão
- cefaleias de início gradativo
- hipertensão
- coma
- deficit neurológico focal de início gradual
- disfunção cognitiva
Fatores de risco
- familiar (malformação)
- hemorragias prévias (risco de hemorragia)
- abuso de drogas (risco de hemorragia)
- drenagem venosa anormal (risco de hemorragia)
- MAVs pequenas (risco de hemorragia)
- MAVs profundas e na fossa posterior (risco de hemorragia)
- aneurismas coexistentes (risco de hemorragia)
- gravidez (risco de hemorragia)
- hipertensão (risco de hemorragia)
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- tomografia computadorizada (TC) cerebral
- ressonância nuclear magnética (RNM) cranioencefálica
Investigações a serem consideradas
- angiografia digital cerebral por subtração
- angiotomografia cranioencefálica
- angiografia por ressonância magnética cerebral
- Hemograma completo
- exames de coagulação e grupo sanguíneo
- painel de eletrólitos
- análise toxicológica de drogas
- exames funcionais por imagem
- Wada superseletivo
- neuropsicologia
- estudos de perfusão
- eletroencefalograma
- campos visuais
Novos exames
- angiotomografia 4D (ATG)/angiografia por ressonância magnética (ARM)
Algoritmo de tratamento
hematoma associado com efeito de massa significativo
não candidato à cirurgia
candidato à cirurgia
gestante
Colaboradores
Autores
Mervyn Lim, MBBS, MRCS, MPH
Senior Resident
Department of Neurosurgery
National University Health System
Singapore
Declarações
ML declares that he has no competing interests.
Leonard Yeo, MBBS, MRCP, MMed, ASN
Senior Consultant
Department of Medicine (Neurology)
National University Health System
Assistant Professor
Yong Loo Lin School of Medicine
National University of SIngapore
Singapore
Declarações
LY declares that he has no competing interests.
Benjamin Tan, MBBS, MRCP, MMed
Associate Consultant
Department of Medicine (Neurology)
National University Health System
Singapore
Declarações
BT declares that he has no competing interests.
Adriel Leong, MBBS, MRCS
Senior Resident
Department of Neurosurgery
National University Health System
Singapore
Disclosures
AL declares that he has no competing interests.
Audrey Tan, BSc Medical Sciences (Hons), MBChB, MRCS
Senior Resident
Department of Neurosurgery
National University Health System
Singapore
Disclosures
AT declares that he has no competing interests.
Pervinder Bhogal, MBBS
Consultant
Department of Radiology
St Bartholomew's and The Royal London Hospital
London
UK
Disclosures
PB declares that he has no competing interests.
Yang Cunli, MBBS, FRCR, MMed, FAMS
Senior Consultant
Department of Diagnostic Imaging
National University Health System
Assistant Professor
Yong Loo Lin School of Medicine
National University of Singapore
Singapore
Disclosures
YC declares that he has no competing interests.
Anil Gopinathan, MBBS, MD, DNB, FRCR, FAMS
Head of Division of Interventional Radiology
Senior Consultant
Department of Diagnostic Imaging
National University Health System
Assistant Professor
Yong Loo Lin School of Medicine
National University of Singapore
Singapore
Disclosures
AG declares that he has no competing interests.
Acknowledgements
Dr Leonard Yeo, Dr Benjamin Tan, Dr Adriel Leong, Dr Audrey Tan, Dr Mervyn Lim, Dr Pervinder Bhogal, Dr Yang Cunli, and Dr Anil Gopinathan would like to gratefully acknowledge Dr Charles Matouk, Dr Catherine E. Gilkes, and Dr Richard J. Edwards, previous contributors to this topic, and the additional contribution of Dr Branden Cord and Dr Ryan Hebert.
Disclosures
CM, CEG, and RJE declare that they have no competing interests.
Peer reviewers
Bernhard Meyer, MD
Chairman
Professor of Neurosurgery
Department of Neurosurgery
Technical University of Munich
Munich
Germany
Divulgaciones
BM declares that he has no competing interests.
Michael Chen, MD
Assistant Professor of Neurology
Neurosurgery and Radiology
Rush University Medical Center
Chicago
IL
Divulgaciones
MC declares that he has no competing interests.
Jae H. Choi, MD
Research Director
Stroke Center/The Neurological Institute
Columbia-Presbyterian Medical Center
New York
NY
Divulgaciones
JHC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referencias
Artículos principales
Al-Shahi R, Warlow C. A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. Brain. 2001 Oct;124(Pt 10):1900-26.Texto completo Resumen
Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986 Oct;65(4):476-83. Resumen
Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022 Jul;53(7):e282-361.Texto completo Resumen
Derdeyn CP, Zipfel GJ, Albuquerque FC, et al. Management of brain arteriovenous malformations: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017 Aug;48(8):e200-24. Resumen
Zuurbier SM, Al-Shahi Salman R. Interventions for treating brain arteriovenous malformations in adults. Cochrane Database Syst Rev. 2019 Sep 10;9(9):CD003436.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Aneurisma cerebral
- Hemangioma cavernoso
- Fístula arteriovenosa dural
Más DiferencialesGuías de práctica clínica
- Guidelines for the management of spontaneous intracerebral hemorrhage
- Clinical practice guidelines for management of brain arteriovenous malformations in eloquent areas
Más Guías de práctica clínicaFolletos para el paciente
AVC: tratamento
Más Folletos para el paciente
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