Can developmental venous anomalies cause seizures?
Can developmental venous anomalies cause seizures?
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DOI：
10.1007/s00415-017-8456-5
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发表时间：
2017-12-01
影响因子：
6
通讯作者：
Denier, Christian
中科院分区：
文献类型：
--
作者：
Dussaule, Claire;Masnou, Pascal;Denier, Christian
发育性静脉异常（DVA）是正常大脑正常静脉引流的先天性解剖变异。尽管 DVA 经常在癫痫发作时被发现，但对它们与癫痫的关系的研究却很少。我们的目的是确定在没有相关病变（包括没有海绵状血管瘤或发育不良）的情况下，DVA 是否会引起癫痫发作。根据临床病史、脑 MRI、脑电图记录和 F-18-FDG PET，我们报告了 4 例因癫痫发作而发现 DVA 的患者。第一位患者因 DVA 血栓形成出血性梗塞而导致惊厥性癫痫发作。第二名患者的左颞顶叶 DVA 靠近非特异性病变，可能是静脉梗塞的后遗症。最后两名患者披露了一次孤立且不复杂的 DVA，并在发作期视频脑电图记录中证实了一致的癫痫病灶。我们回顾了文献并确定了另外 21 例已发表的由 DVA 并发症引起的癫痫发作病例，以及 9 例可能与孤立且无并发症的 DVA 之间有直接联系的患者。癫痫发作在两种主要情况下与 DVA 有关：存在相关的致痫性病变，例如海绵状血管瘤或发育不良，以及发生 DVA 并发症。在得出癫痫发作是由 DVA 引起的结论之前，必须执行完整的 MRI 方案来检查癫痫发作。孤立且无并发症的 DVA 会导致癫痫发作的情况仍然罕见且不确定。在最后一种情况下，每个患者的病理生理过程可能不同。
Developmental venous anomalies (DVAs) are congenital anatomical variants of normal venous drainage of normal brain. Although DVAs are often discovered on the occasion of a seizure, their involvement in epilepsy is poorly studied. Our objective was to determine whether DVA can cause seizures, in the cases where there is no associated lesion, including no cavernoma or dysplasia. Based on clinical history, cerebral MRI, EEG recording, and F-18-FDG PET, we report 4 patients with DVA revealed by seizures. The first patient had a convulsive seizure caused by a hemorrhagic infarction due to thrombosis of her DVA. The second patient had a left temporo-parietal DVA next to a nonspecific lesion, possibly a sequelae of a venous infarction. The last two patients disclosed an isolated and uncomplicated DVA with a concordant epileptic focus confirmed on ictal video EEG recording. We reviewed literature and identified 21 other published cases of seizures caused by complications of a DVA and 9 patients that may have a direct link between epilepsy and an isolated and uncomplicated DVA. Seizures are linked to a DVA in two main situations: presence of an associated epileptogenic lesion, such as cavernoma or dysplasia, and occurrence of a complication of the DVA. Before concluding that a seizure is caused by a DVA, it is essential to perform full MRI protocols to search them. It remains rare and uncertain that isolated and uncomplicated DVA can cause seizures. In this last situation, physiopathological processes are probably different in each patient.