Arteriovenous malformation in the carotid artery bifurcation as a rare cause of syncope: a case report
Abstract
Background: Arteriovenous malformation (AVM) is defined as a convolute of abnormally connected arteries and veins, where capillary bed is missing. The most common localization of AVM is intracranial.
Brain malformations are about 20 times more frequent than extracerebral ones. Clinical signs depend on the localization of the malformation; besides local pain or bleeding, steal phenomenon often can be seen.
Case report: We present a case of a 61-year-old woman, who was admitted to the hospital because of recurrent syncopes. During the neurosonologic examination we could see the acceleration of blood flow in the left common carotid artery (133 cm/s), a huge convolute of the vessels in the area of its bifurcation and accelerated, low resistant flow in the origin of external carotid artery with PSV 270 cm/s and low resistance index (0.3-0.4).
The changes were seen also in the venous part, with sings of arterial flow there. Magnetic resonance angiography was performed, and confirmed a large malformation in the carotid artery bifurcation (about 8 cm).
The patient was sent to endovascular diagnostics and treatment; on digital subtraction angiography, a high-flow malformation of left lingual artery on the left half of the tongue was diagnosed. The selective embolization of the lingual artery by the coils was performed with very good radiologic and clinical outcome.
Conclusions: A thorough neurosonologic examination is important and can raise the suspicion of an arteriovenous malformation, as in this very unusual case.