title: Severely impaired cerebrovascular reserve in patients with cerebral proliferative angiopathy.
abstract: OBJECTIVE
  Cerebral proliferative angiopathy (CPA) has been morphologically distinguished from classically appearing brain arteriovenous malformations (AVMs) by exhibition of functional brain parenchyma that is intermingled with abnormal vascular channels. The presence of oligemia in this intralesional brain tissue may suggest ischemia, which is not detected in classic brain AVMs. The authors hypothesized that patients with CPA would exhibit a greater impairment of cerebrovascular reserve in neuronal tissue surrounding the true nidus compared with those with brain AVMs.
  
  
  METHODS
  Four patients with CPA, 10 patients with brain AVMs and seizures, and 12 young healthy individuals were studied. The 4 patients with CPA underwent blood oxygen level-dependent MR imaging examinations while applying normoxic step changes in end-tidal CO(2) to obtain quantitative cerebrovascular reactivity measurements.
  
  
  RESULTS
  Patients with a CPA lesion exhibited severely impaired perilesional cerebrovascular reserve in comparison with patients with brain AVMs and seizures (0.10 ± 0.03 vs 0.16 ± 0.03, respectively; p < 0.05), and young healthy individuals (0.10 ± 0.03 vs 0.21 ± 0.06, respectively; p < 0.01).
  
  
  CONCLUSIONS
  This study demonstrated severely impaired cerebrovascular reserve in the perilesional brain tissue surrounding the abnormal vessels of patients with CPA. This finding may provide an additional means to distinguish CPA from classic brain AVMs.
authors: Division of Neurosurgery, University Health Network, University of Toronto, Ontario, Canada.
authors: Jorn
authors: J
authors: Fierstra
authors: Stephanie
authors: S
authors: Spieth
authors: Leanne
authors: L
authors: Tran
authors: John
authors: J
authors: Conklin
authors: Michael
authors: M
authors: Tymianski
authors: Karel G
authors: KG
authors: ter Brugge
authors: Joseph A
authors: JA
authors: Fisher
authors: David J
authors: DJ
authors: Mikulis
authors: Timo
authors: T
authors: Krings
mesh_terms: D001921:Brain / Q000098:blood supply / Q000473:pathology; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology; D002245:Carbon Dioxide / Q000378:metabolism; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D003937:Diagnosis, Differential; D004827:Epilepsy / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000145:classification* / Q000150:complications / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide