Vascular intracranial malformations and dementia: An under-estimated cause and clinical correlation. Clinical note

Luigi Valentino Berra; Daniele Armocida; Luca D'Angelo; Valerio Di Norcia; Antonio Santoro

doi:10.1016/j.cccb.2022.100146

Vascular intracranial malformations and dementia: An under-estimated cause and clinical correlation. Clinical note

Cereb Circ Cogn Behav. 2022 May 18:3:100146. doi: 10.1016/j.cccb.2022.100146. eCollection 2022.

Authors

Luigi Valentino Berra¹, Daniele Armocida¹, Luca D'Angelo¹, Valerio Di Norcia¹, Antonio Santoro¹

Affiliation

¹ A.U.O. "Policlinico Umberto I" - Neurosurgery Division - Sapienza University - Rome - Human Neurosciences Department - Via del Policlinico, 155 - 00161 - Roma, Italy.

Abstract

Cerebrovascular malformations (CVMs) such as arteriovenous malformations (AVMs) or dural arteriovenous fistulas (DAVFs) represent a possible source of intracranial hemorrhage, but these malformations can also manifest with neurologic disorders secondary to ischemic penumbra from vascular steal. In the latter case, the clinical manifestations are less obvious and characteristic, and may include a varied clinical spectrum ranging from focal deficits to generalized malfunction of the brain parenchyma resulting in dementia. Dementias secondary to CVMs constitute a probably underestimated subpopulation of patients of great interest because they present with devastating but potentially reversible cognitive impairment. We examined the pertinent literature regarding the clinical manifestations of CVMs characterized by cognitive impairment and describe the distinctive clinical features. Our results confirm that cognitive impairment is one of the clinical manifestations of CVMs and is a frequently misrecognized and often late-diagnosed cause of reversible dementia.

Keywords: AVMs, Cerebral arteriovenous malformations; CSF, cerebrospinal fluid; Cerebral arteriovenous malformations; DAVFs, Dural arteriovenous fistulas; DSA, Digital subtraction angiography; DWI, diffusion-weighted imaging; Dural arteriovenous fistula; Endovascular treatment; MR-DSA, MR digital subtraction angiography; PET, positron emission tomography; RPD, Rapidly progressive dementia; Rapidly progressive dementia; SPECT, single-photon emission computed tomography.