Spontaneous Regression Of A Thrombosed Cerebral Arteriovenous Malformation In A Patient With A Prothrombotic State Associated With Multiple Myeloma: A Case Report And Literature Review
Arenas-Ruiz, J. A., Hernández-Álvarez, N., de Llano, J. P. N., Ponce-Ayala, A., & Nathal, E. (2021). Spontaneous regression of a thrombosed cerebral arteriovenous malformation in a patient with a prothrombotic state associated with multiple myeloma: A case report and literature review. Surgical neurology international, 12, 521. https://doi.org/10.25259/SNI_666_2021
View Original Source →Abstract
BACKGROUND: Cerebral arteriovenous malformations (AVMs) are pathologic communications between veins and arteries of the brain vasculature. Its spontaneous regression is rare, and many factors have been described in the effort to explain this phenomenon, including a hypercoagulable state. CASE DESCRIPTION: We present the case of a spontaneous unruptured AVM regression in a patient where thrombosis of the malformation was found, probably due to a prothrombotic state associated with multiple myeloma (MM). CONCLUSION: We aim to contribute to the study of this rare phenomenon, presenting the relationship between a hypercoagulable state caused by MM and the spontaneous AVM regression that has not been previously reported.
Case Details
Disease Location
Brain vasculature
Personal Characteristics
49-year-old male, spontaneous deep venous thrombosis (dvt) treated with 5mg daily apixaban (suspended 3 months later due to gastrointestinal bleeding)
Clinical Characteristics
5 months after dvt, the patient presented with a severe headache. MRI showed a right occipital arteriovenous malformation spetzler-martin grade ii. Its afferent vessel was the posterior cerebral artery and venous drainage through the right transverse and straight sinus. 2 months later, he was diagnosed with multiple myeloma (mm) IGG kappa, iss iii, and iiib durie-salmon. He received 15 cycles of 28 days each with thalidomide 100 mg/day, cyclophosphamide 50 mg/ day, dexamethasone 20 mg weekly, and one dose of 4 mg zoledronic acid. 10 months later, the patient had partial seizures with visual hallucinations head CT scan showed a hyperdense serpentigenous trace in the right parieto-occipital region, with a hypodensity adjacent to this area and without evidence of hemorrhage.
Remission Characteristics
In a cerebral angiography 20 days postevent, the avm was no longer observed.
Treatment & Mechanisms
Proposed Remission Mechanisms
Prothrombotic state associated with multiple myeloma
Clinical Treatment
Apixaban, chemotherapy
Non-Clinical Treatment
None reported