Intracranial Steal Syndromes

In some patients with arteriovenous malformations (AVMs) that are large and are fed by both deep and superficial vessels, there has been some anecdotal clinical support for intracerebral steal. The theory is that the presence of low-resistance shunt vessels compromises blood and nutrient flow to adjacent areas of the brain supplied by the same blood vessels, causing transient or permanent damage to neurons. y The clinical reports, although limited in number, report that these patients with AVMs have a variety of focal neurological deficits, cognitive deficits, visual deficits, and seizures that recover after the AVM is excised. In most patients, the neurological deficits are confined to the area of the brain supplied by the AVM. However, there have been reports of EEG abnormalities in the hemisphere contralateral to the AVM and lower cerebral blood flow in the contralateral hemisphere that may support relative areas of ischemia. '521 More documentation of this syndrome in large numbers of patients is needed.

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