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Arteriovenous Malformations

more about Arteriovenous Malformations

  • In normal brain tissue, there are minute blood vessels (capillaries) that connect the ends of smallest arterioles with the smallest veins.  In arteriovenous malformation (AVM), blood is shuttled directly from the artery to the vein, where the blood flow is high and the venous pressure is elevated.  This high blood pressure may cause Seizures or hemorrhages of arteriovenous malformation.
  • An arteriovenous malformation (AVM) is a cluster of abnormal blood vessels composed of direct arterial to venous connections without intervening capillary beds.

  • Symptoms are most likely to occur in young adults between the ages of 20-40.
  • Patients do not know that they have an AVM until it causes Seizures, intra-cerebral hemorrhages or Subarachnoid Hemorrhages with severe headaches.  A number of patients with AVM have a history of chronic headaches or Seizures.
  • Sudden onset of headaches, nausea and vomiting
  • Mental status change
  • Neurological problems, such as paralysis of the arms and legs
  • Visual problems and/or difficulties with speech
  • Seizures

  • People are born with AVMs, although they are not an inherited trait.
  • The cause of abnormal blood vessel formation is unknown
  • Arteriovenous malformation of the brain occurs in 3 out of 10,000 people.

  • Brain MRI scan
  • Brain CT scan
  • Cerebral Angiography -- X-Ray examinations that expose the arteries and veins of the brain.  It shows the abnormal blood vessels of AVM in detail, and is used for inpatient procedures before treatment
  • An Electroencephalogram (EEG) may be needed if the patient experiences Seizures.

  • Surgery -- The AVM is removed by resection or by a ligation.  If the AVM is deeply set, a surgical approach is impossible.
  • Radiation therapy -- radiation beams cause the destruction and scarring of the AVM.  Small, deep lesions can be treated this way without a craniotomy.
  • Embolization --The AVM is plugged with a clot-like substance that is injected into the abnormal blood vessels through a tiny tube.  It is performed with an Angiography to identify the AVM mass and directly inject the clot-like substances.  Therefore, a craniotomy is not needed.  A large AVM often requires multiple procedures.
  • In large AVM, embolization is helpful to reduce the AVM size before surgery.
  • Anti-seizure medications

  • The probability of survival following a hemorrhage is 90%, but in some cases, neurological sequelae such as paralysis, swallowing problems, Speech Problems and/or intellectual dysfunction may persist after a hemorrhage.

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