Between Seizures and Ischemic Events: A Challenging Case of Brain Arteriovenous Malformation

Cellante G1*, Vergobbi P1, Nilo A1,2, Verriello L3, Gigli GL2, Valente M1,2# and Pauletto G3#

1Department of Medicine (DMED), University of Udine, Italy
2Department of Head-Neck and Neurosciences, Clinical Neurology Unit, Santa Maria Della Misericordia University Hospital, Italy
3Department of Head-Neck and Neurosciences, Neurology Unit, Santa Maria Della Misericordia University Hospital, Italy
#These authors share senior authorship

^*Correspondance to: Giulia Cellante 

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Abstract:

Arteriovenous Malformations (AVM) are complex vascular lesions characterized by the absence of capillary bed between arteries and veins, which can present with a great variety of symptoms. We describe the case of a patient with an AVM presenting repeated episodes of aphasic and apraxic symptomatology lasting no more than 24 h, leading to differential diagnosis between seizures and transient ischemic attacks. The case concerns a 77-year-old woman with a hemispheric AVM. Since her diagnosis in 1995, she has experienced several episodes characterized by ambiguous symptoms, with a differential diagnosis between epileptic seizures and vascular steal phenomena. Due to the inability to distinguish between the two conditions, Anti-Seizure Medication (ASM) was initiated and subsequently implemented. Neither the clinical presentation, nor the instrumental examinations such as CT and Electroencephalogram (EEG), showed alterations that could favor one condition over the other. A final episode, different from the previous ones and with EEGs clearly showing epileptic activity, occurred in September 2023 and led to the patient's admission to intensive care. Ultimately, considering our patient’s history, it is reasonable to consider most of the episodes as the result of vascular steal, whereas the last one was a motor seizure, possibly due to prolonged and repetitive ischemic insults. Therefore, in these cases, initiating antiepileptic therapy is probably not advisable. We recommend a careful evaluation of clinical signs, risk factors, and instrumental data (CT and MRI scans, EEG, and Doppler ultrasound) to avoid both unnecessary medications and the underestimation of possible epileptic seizures.

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Cite the Article:

Cellante G, Vergobbi P, Nilo A, Verriello L, Gigli GL, Valente M, et al. Between Seizures and Ischemic Events: A Challenging Case of Brain Arteriovenous Malformation. Ann Clin Case Rep. 2024; 9: 2657..