ĐẶC ĐIỂM LÂM SÀNG VÀ CẬN LÂM SÀNG, HÌNH ẢNH SIÊU ÂM DOPPLER XUYÊN SỌ (TCD) CỦA BỆNH NHÂN CHẢY MÁU NÃO DO VỠ DỊ DẠNG THÔNG ĐỘNG TĨNH MẠCH NÃO (AVM)

Abstract

Objectives: To describe subclinical and clinical characteristics, transcranial Doppler (TCD) ultrasound imaging; and assess the value of transcranial Doppler ultrasoundin patients with intracranial hemorrhage due to ruptured cerebral arteriovenous malformation (AVM). Methods: A descriptive cross-sectional study of 36 cases with ruptured cerebral arteriovenous malformation (AVM) who weretreated at Bach Mai Hospital from October 2019 to July 2021. Results: Mean age was 43±14,7 years old, male/female ratio was 1,27/1. Admisssion reasons: Nausea/vomitting were 97,2%, headache was 94,4%, altered level of consciousness was 30.6% and 50% with hemiplegia. The common hemorrhagic location were in cerebral lobules. The percentage of hematoma sizes smaller than 3cm, from 3 to 6cm and greater than 6cm were 58.3%, 38.9%, and 2.8% respectively. The ruptured AVM feeding vessels originate from midle cerebral artery were 52,78%. The AVM had 3 or 4 feeding arteries were 91,67%, had more than 4 feeding arteries were 8,33%. The AVM with pure one draining vein was 72,2%, with 2 or more draining veins was 27.8%. The confirmed diagnostic rate of AVM feb by middle cerebral artery branches by TCD ultrasound was 89,47%. Postive prediction value based on CTA for small, medium and large AVM was 40,9% 93,75% and 100% respectively.  Mean flow velocity on the feeding vessels originate from MCA was higher than those in the contralateral MCA. (significant difference, with p <0,05).  Conclusion: The predominant age group in ruptured AVM was 40 years old and above (63,9%); the mean age was 43 ± 14,7, male/female ratio was 1,27/1. The common hemorrhagic location were in cerebral lobules (85,72%), hematoma sizes smaller than 3cm with pure one draining vein was 72,2%. TCD ultrasound was the useful tool to diagnose the medium and large AVM with high sensitivity.