Linking Brain Arteriovenous Malformations With Anorectal Hemorrhoids: A Clinical and Anatomical Review

Anat Rec (Hoboken). 2017 Nov;300(11):1973-1980. doi: 10.1002/ar.23643. Epub 2017 Jul 21.

Abstract

Patients who harbor brain arteriovenous malformations are at risk for intracranial hemorrhage. These malformations are often seen in inherited vascular diseases such as hereditary hemorrhagic telangiectasia. However, malformations within the brain also sporadically occur without a hereditary-coding component. Here, we review recent insights into the pathophysiology of arteriovenous malformations, in particular, certain signaling pathways that might underlie endothelial cell pathology. To better interpret the origins, determinants and consequences of brain arteriovenous malformations, we present a clinical case to illustrate the phenotypic landscape of the disease. We also propose that brain arteriovenous malformations might share certain signaling dimensions with those of anorectal hemorrhoids. This working hypothesis provides casual anchors from which to understand vascular diseases characterized by arteriovenous lesions with a hemorrhagic- or bleeding-risk component. Anat Rec, 2017. © The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists. Anat Rec, 300:1973-1980, 2017. © 2017 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.

Keywords: hereditary hemorrhagic telangiectasia; intracranial hemorrhage; magnetic resonance imaging; nutritional substances; vascular dysmorphogenesis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Activin Receptors, Type II / genetics
  • Activin Receptors, Type II / metabolism
  • Adult
  • Arteriovenous Fistula / diagnostic imaging
  • Arteriovenous Fistula / diet therapy
  • Arteriovenous Fistula / genetics
  • Arteriovenous Fistula / pathology*
  • Blood Pressure
  • Brain / blood supply*
  • Brain / diagnostic imaging
  • Dietary Fiber / therapeutic use
  • Endoglin / genetics
  • Endoglin / metabolism
  • Endothelial Cells / pathology*
  • Humans
  • Intracranial Arteriovenous Malformations / diagnostic imaging
  • Intracranial Arteriovenous Malformations / diet therapy
  • Intracranial Arteriovenous Malformations / genetics
  • Intracranial Arteriovenous Malformations / pathology*
  • Magnetic Resonance Angiography
  • Male
  • Mutation
  • Signal Transduction / genetics*
  • Telangiectasia, Hereditary Hemorrhagic / diet therapy
  • Telangiectasia, Hereditary Hemorrhagic / genetics
  • Telangiectasia, Hereditary Hemorrhagic / pathology*
  • Tomography, X-Ray Computed
  • Transforming Growth Factor beta / metabolism

Substances

  • Dietary Fiber
  • ENG protein, human
  • Endoglin
  • Transforming Growth Factor beta
  • ACVRL1 protein, human
  • Activin Receptors, Type II