title: Pulmonary arteriovenous malformations: cerebral ischemia and neurologic manifestations.
abstract: BACKGROUND
  There is an increasingly recognized association between pulmonary arteriovenous malformations (PAVM) and cerebral ischemia, frequently attributed to paradoxical embolization. PAVM occur in 20 to 30% of the hereditary hemorrhagic telangiectasia (HHT) population.
  
  
  OBJECTIVE
  To evaluate the risk determinants for cerebral ischemia and neurologic manifestations in patients with PAVM.
  
  
  METHODS
  A retrospective cross-sectional study was performed on consecutive patients admitted between 1988 and 1992 for treatment of PAVM. The number of PAVM, feeding artery (FA) diameters, and aneurysmal sizes were determined by pulmonary angiography. Patients were categorized as having single or multiple PAVM with an FA diameter of > or = 3 mm. History, examination, and cerebral imaging studies were used to determine the prevalence of neurologic manifestations. Patients were defined as having cerebral paradoxical embolization if there was radiologic evidence of cortical infarction.
  
  
  RESULTS
  There were 75 cases: 26 single PAVM and 49 multiple PAVM. Cortical infarction was present in 14% of patients with single PAVM. Patients with multiple PAVM had a greater prevalence of any infarction (OR 3.2; 95% CI, 1.2 to 9.44, p = 0.030), cortical infarctions (OR 2.3; 95% CI, 0.58 to 9.2, p = 0.230), subcortical infarctions (OR 2.1; 95% CI, 0.58 to 7.95, p = 0.249), abscesses (OR 2.3; 95% CI, 0.46 to 11.94; p = 0.295), and seizures (OR 6.4, 95% CI 0.77 to 53.2, p = 0.054). Patients with multiple PAVM had markedly greater odds of having any clinical or radiologic evidence of cerebral ischemic involvement (OR 4.5; 95% CI, 1.47 to 14; p = 0.008).
  
  
  CONCLUSIONS
  There is a strong association between single PAVM and various neurologic manifestations. The prevalence is greater for patients with multiple PAVM, suggesting increased predisposition for paradoxical embolization with a greater number of malformations.
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA. arista1@pol.net
authors.forename: M
authors.initials: M
authors.lastname: Moussouttas
authors.forename: P
authors.initials: P
authors.lastname: Fayad
authors.forename: M
authors.initials: M
authors.lastname: Rosenblatt
authors.forename: M
authors.initials: M
authors.lastname: Hashimoto
authors.forename: J
authors.initials: J
authors.lastname: Pollak
authors.forename: K
authors.initials: K
authors.lastname: Henderson
authors.forename: T Y
authors.initials: TY
authors.lastname: Ma
authors.forename: R I
authors.initials: RI
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D001165:Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors