Description

A brain arteriovenous malformation (AVM) is a tangle of blood vessels that creates irregular connections between arteries and veins in the brain.

Arteries take oxygen-rich blood from the heart to the brain. The veins carry oxygen from the blood to the lungs and the heart. A brain AVM disrupts this vital process.

An arteriovenous malformation can develop anywhere in the body, but common places are the brain and the spinal cord. In general, brain Avms are rare.

The cause of brain Avms is not clear. Most of the people are born with them, but they can form later in life. Rarely, AVM can be a trait transmitted in families.

Some people with brain arteriovenous malformations experience symptoms such as headaches or seizures. A brain AVM can be found after a brain scan for another health problem. Sometimes a brain AVM is located after the blood vessels burst and bleed, known as a hemorrhage.

Once diagnosed, a brain AVM can be treated to prevent complications such as brain damage or stroke.

Symptoms

A brain arteriovenous malformations (AVMS) may not cause any symptoms until the AVM bursts and bleeds, known as a hemorrhage. In about half of all brain arteriovenous malformations, hemorrhage, is the first sign of the malformation.

But some people with brain Avms may experience other symptoms of bleeding, such as:

  • Seizures.
  • Headaches or pain in one area of the head.
  • Muscle weakness or numbness of one part of the body.

Some people may experience more severe symptoms depending on the location of the AVM, including:

  • A very bad headache.
  • Weakness, numbness or paralysis.
  • The loss of vision.
  • Difficulty speaking.
  • Confusion or not being able to understand others.
  • Problems with walking.

The symptoms of a brain AVM can begin at any age, but usually occur between the ages of 10 and 40. Brain Avms can cause damage to the brain tissue over time. The effects build up gradually and often cause symptoms in early adulthood.

By the middle ages, however, brain arteriovenous malformations tend to remain stable and are less likely to cause symptoms.

When to see a doctor

Get immediate medical attention if you notice any of the symptoms of a brain AVM, such as seizures, headaches, or other symptoms. Bleeding in the brain AVM is dangerous and requires emergency medical attention.

Causes

The cause of brain arteriovenous malformations (Avms) is not known. The researchers believe that the majority of brain arteriovenous malformations are present at birth and is formed during the growth of the baby in the uterus. But the brain Avms can occur later in life.

Brain Avms are seen in some people who have the hereditary hemorrhagic telangiectasia (HHT). HHT is also known as Osler-Weber-Rendu syndrome. HHT affects the way in which blood vessels form in various areas of the body, including the brain.

Normally, the heart sends oxygen-rich blood to the brain through the arteries. The arteries reduce the flow of blood by the passage of the blood through a series of small and very small blood vessels. The smallest of the blood vessels called capillaries. The capillaries slowly deliver oxygen through their thin, porous walls to the surrounding brain tissue.

The oxygen of the blood passes into the small blood vessels and then into larger veins. The veins carry the blood back to the heart and lungs to receive more oxygen.

The arteries and veins in an AVM this lack of support from the network of small blood vessels and capillaries. Instead, the blood flows quickly and directly from the arteries to the veins. When this happens, the surrounding tissues of the brain not receive the oxygen it needs.

Risk factors

Any person may be born with a brain arteriovenous malformation (AVM), but these factors may increase the risk of:

  • The fact of being a man. Brain Avms are more common in men.
  • Having a family history. Rarely, brain Avms occur in families, but it is not clear if there is a certain genetic risk factor. It is also possible to inherit from other medical conditions that increase the risk of brain arteriovenous malformations, such as hereditary hemorrhagic telangiectasia (HHT).

Complications

Complications of brain arteriovenous malformations (AVMS), which include:

  • Bleeding in the brain.A brain AVM puts a lot of pressure on the walls of the affected arteries and veins. The pressure causes the arteries and the veins become more thin, or weak. This can result in the AVM rupture and bleeding into the brain, known as a hemorrhage. This risk of a brain AVM hemorrhage ranges from about 2% to 3% each year. The risk of bleeding may be greater for certain types of AVM. The risk may be greater in people who have had a brain AVM bleed in the past. Although studies have not found that pregnancy increases the risk of bleeding in people with a brain AVM, more research is needed. Some of the bleeding associated with brain arteriovenous malformations are not detected because they do not cause major symptoms. However, potentially dangerous bleeding may occur. The brain Avms represent approximately 2% of all hemorrhagic strokes each year. In children and young adults who suffer from a brain hemorrhage, brain Avms are often the cause.
  • The reduction of oxygen to brain tissue.With a brain AVM, blood does not flow through the network of tiny blood vessels called capillaries. Instead, it flows directly from arteries to veins. The blood runs fast because it is not slowed down by the smallest blood vessels. The surrounding brain tissue cannot easily absorb the oxygen from the fast flow of blood. Without enough oxygen, the brain tissues weaken and may die completely. This results in the stroke-like symptoms, such as difficulty speaking, weakness, numbness, loss of vision, or difficulty to keep stable.
  • Thin or weak blood vessels. An AVM puts a lot of pressure on the thin and weak the walls of the blood vessels. A bulge in a wall of the blood vessels, known as an aneurysm, it can form. The aneurysm may be at risk of outbreak.
  • The brain damage.The body can use more of the arteries that supply blood to the fast-flowing brain AVM. As a result, some of the Avm can be made larger and displace or compress parts of the brain. This can prevent the protection of the fluids flowing freely throughout the entire brain. If the fluid builds up, this can push the tissues of the brain against the skull.

Bleeding in the brain. A brain AVM puts a lot of pressure on the walls of the affected arteries and veins. The pressure causes the arteries and the veins become more thin, or weak. This can result in the AVM rupture and bleeding into the brain, known as a hemorrhage.

This risk of a brain AVM hemorrhage ranges from about 2% to 3% each year. The risk of bleeding may be greater for certain types of AVM. The risk may be greater in people who have had a brain AVM bleed in the past.

Although studies have not found that pregnancy increases the risk of bleeding in people with a brain AVM, more research is needed.

Some of the bleeding associated with brain arteriovenous malformations are not detected because they do not cause major symptoms. However, potentially dangerous bleeding may occur.

The brain Avms represent approximately 2% of all hemorrhagic strokes each year. In children and young adults who suffer from a brain hemorrhage, brain Avms are often the cause.

The reduction of oxygen to brain tissue. With a brain AVM, blood does not flow through the network of tiny blood vessels called capillaries. Instead, it flows directly from arteries to veins. The blood runs fast because it is not slowed down by the smallest blood vessels.

The surrounding brain tissue cannot easily absorb the oxygen from the fast flow of blood. Without enough oxygen, the brain tissues weaken and may die completely. This results in the stroke-like symptoms, such as difficulty speaking, weakness, numbness, loss of vision, or difficulty to keep stable.

The brain damage. The body can use more of the arteries that supply blood to the fast-flowing brain AVM. As a result, some of the Avm can be made larger and displace or compress parts of the brain. This can prevent the protection of the fluids flowing freely throughout the entire brain.

If the fluid builds up, this can push the tissues of the brain against the skull.

A type of brain AVM, which implies a major blood vessel called the vein of Galen causes serious complications in infants. Symptoms are present at birth or appear shortly after birth. This type of brain AVM causes the accumulation of fluid in the brain and the head to swell. Inflammation of the veins can be seen on the scalp, and seizures may occur. Children with this type of brain AVM may have a delay and congestive heart failure.

Diagnosis

To diagnose a problem of brain arteriovenous malformations (AVMS), your health care professional to review your symptoms and perform a physical examination.

One or more tests may be used to diagnose a brain AVM. Imaging tests are usually performed by radiologists trained in brain and nervous system of the image, known as neuroradiologists.

The tests used to diagnose brain arteriovenous malformations include:

  • Cerebral angiography.This is the most detailed test to diagnose an AVM in the brain. Cerebral angiography revealed the location of the feeding arteries and draining veins, which is fundamental for treatment planning. Cerebral angiography is also known as cerebral arteriography. In this test, a long, thin tube called a catheter is inserted into an artery in the groin or wrist. The catheter is passed to the brain by means of x-ray images. a dye Is injected into the blood vessels of the brain to make them visible on x-ray images.
  • Computed tomography (CT scan).A ct scan uses a series of X-rays to create a detailed cross-sectional image of the brain. Sometimes, a dye is injected through a tube into a vein to the TC. This type of test is known as computed tomography angiography. The dye allows the arteries feeding the AVM and the veins draining the AVM to view in greater detail.
  • Magnetic resonance imaging (MRI).Mri uses powerful magnets and radio waves to create detailed images of the brain. Magnetic resonance imaging is more sensitive than CT and may show subtle changes in brain tissue related to a brain AVM. Magnetic resonance imaging also provides information on the exact location of the AVM of the brain and bleeding in the brain. The information is important for treatment planning. A contrast dye may also be injected to see the circulation of the blood in the brain. This type of test is known as magnetic resonance angiography.

Cerebral angiography. This is the most detailed test to diagnose an AVM in the brain. Cerebral angiography revealed the location of the feeding arteries and draining veins, which is fundamental for treatment planning. Cerebral angiography is also known as cerebral arteriography.

In this test, a long, thin tube called a catheter is inserted into an artery in the groin or wrist. The catheter is passed to the brain by means of x-ray images. a dye Is injected into the blood vessels of the brain to make them visible on x-ray images.

Computed tomography (CT scan). A ct scan uses a series of X-rays to create a detailed cross-sectional image of the brain.

Sometimes, a dye is injected through a tube into a vein to the TC. This type of test is known as computed tomography angiography. The dye allows the arteries feeding the AVM and the veins draining the AVM to view in greater detail.

Magnetic resonance imaging (MRI). Mri uses powerful magnets and radio waves to create detailed images of the brain.

Magnetic resonance imaging is more sensitive than CT and may show subtle changes in brain tissue related to a brain AVM.

Magnetic resonance imaging also provides information on the exact location of the AVM of the brain and bleeding in the brain. The information is important for treatment planning.

A contrast dye may also be injected to see the circulation of the blood in the brain. This type of test is known as magnetic resonance angiography.

Treatment

There are several treatments for brain arteriovenous malformations (AVMS). The main goal of treatment is to prevent bleeding, known as a hemorrhage. The treatment can also help to control seizures or other brain symptoms.

The appropriate treatment depends on your age, health status, and the size and location of the AVM in the brain.

Medications can be used to treat the symptoms caused by the AVM, such as headaches or seizures.

Surgery is the most common treatment for brain Avms. There are three surgical options:

  • Surgical removal, which is known as resection.Surgery may be recommended if the brain AVM has bled or is in an area that can be easily reached. In this procedure, the surgeon removes part of the skull to access the AVM. With the help of a powerful microscope, the surgeon will seal the AVM with special clips and remove the surrounding brain tissue. Then, the surgeon reattaches to the bone of the skull and the incision is closed in the scalp. Resection is usually done when the AVM can be removed with little risk of hemorrhage or seizures. Avms that are in deep regions of the brain have a higher risk of complications, and other treatments may be recommended.
  • Endovascular embolization.In this procedure, a catheter is inserted in an artery of the leg or the wrist. The catheter is inserted through the blood vessels of the brain using x-ray images. The catheter is placed in one of the arteries that feed the brain AVM. The surgeon injects an embolizing agent. This can be small particles, a gluelike substance, microcoils, or other materials. The embolizing agent that blocks the artery and reduce blood flow into the AVM. Endovascular embolization is less invasive than traditional surgery. Can be done alone, but is often used before other surgical treatments to make them more secure. This is done by reducing the size of the AVM of the brain or of the likelihood of bleeding. In some of the large cerebral arteriovenous malformations, the endovascular embolization can be used to reduce the risk of stroke-like symptoms by redirecting blood to the brain tissue.
  • Stereotactic radiosurgery (SRS).This treatment uses precisely focused radiation to destroy the AVM. This type of surgery does not require cutting into the body in the same way that other surgeries do. In its place, SRS conducts many very specific beam of radiation in the AVM to damage the blood vessels and cause scarring. The healing of the AVM vessels, then slowly close in 1 to 3 years. This treatment can be done for small arteriovenous malformations that are difficult to remove with traditional surgery. You can also do it for Avms that have not caused dangerous bleeding.

Surgical removal, which is known as resection. Surgery may be recommended if the brain AVM has bled or is in an area that can be easily reached. In this procedure, the surgeon removes part of the skull to access the AVM.

With the help of a powerful microscope, the surgeon will seal the AVM with special clips and remove the surrounding brain tissue. Then, the surgeon reattaches to the bone of the skull and the incision is closed in the scalp.

Resection is usually done when the AVM can be removed with little risk of hemorrhage or seizures. Avms that are in deep regions of the brain have a higher risk of complications, and other treatments may be recommended.

Endovascular embolization. In this procedure, a catheter is inserted in an artery of the leg or the wrist. The catheter is inserted through the blood vessels of the brain using x-ray images.

The catheter is placed in one of the arteries that feed the brain AVM. The surgeon injects an embolizing agent. This can be small particles, a gluelike substance, microcoils, or other materials. The embolizing agent that blocks the artery and reduce blood flow into the AVM.

Endovascular embolization is less invasive than traditional surgery. Can be done alone, but is often used before other surgical treatments to make them more secure. This is done by reducing the size of the AVM of the brain or of the likelihood of bleeding.

In some of the large cerebral arteriovenous malformations, the endovascular embolization can be used to reduce the risk of stroke-like symptoms by redirecting blood to the brain tissue.

Stereotactic radiosurgery (SRS). This treatment uses precisely focused radiation to destroy the AVM. This type of surgery does not require cutting into the body in the same way that other surgeries do.

In its place, SRS conducts many very specific beam of radiation in the AVM to damage the blood vessels and cause scarring. The healing of the AVM vessels, then slowly close in 1 to 3 years.

This treatment can be done for small arteriovenous malformations that are difficult to remove with traditional surgery. You can also do it for Avms that have not caused dangerous bleeding.

Sometimes health care professionals decide to monitor an AVM of the brain, rather than treating it. This may be recommended if you have few or no symptoms, or if your AVM is in one area of your brain that is difficult to treat. The monitoring includes regular medical checkups with your health care team.

Potential future treatments

Researchers are studying the best way to predict the risk of bleeding in people with brain AVM. This can help guide treatment decisions. For example, high blood pressure within the AVM and hereditary syndromes that affect the brain can affect the risk of bleeding.

Innovations in imaging technology are also being evaluated. The innovations include 3D images, the brain, the tract mapping, and functional imaging, which produces images of blood flow to certain areas of the brain. The techniques have the potential to improve surgical precision and safety in the removal of brain of the audiovisual media and the preservation of the surrounding blood vessels.

Course of progress in the embolization and radiosurgery, microsurgery techniques are also making possible the use of surgery for the treatment of brain arteriovenous malformations that were difficult to access in the past. Progress is also what is safe to remove arteriovenous malformations of the brain during surgery.

Coping and support

You can take steps to deal with the emotions that can come with a diagnosis of brain arteriovenous malformations (AVMS) and the process of recovery. Consider trying to:

  • Learn about the brain AVM to make informed decisions about your care. Ask your health care professional about the size and location of the AVM in the brain. Ask how it affects your treatment options. As you learn more about brain arteriovenous malformations, you can be more confident in making treatment choices.
  • Accept your emotions. Complications of AVM of the brain, such as hemorrhage and stroke, which can cause emotional concerns, as well as the physical. Recognize that experiencing emotions is common. Some emotional and mood changes can be caused by the injury itself, along with coming to terms with the diagnosis.
  • Keep friends and family close. Keep your close relationships strong support during recovery. Friends and family can provide the practical support you need, such as to come with you to medical appointments, and provide emotional support.
  • Find someone to talk to. Find a good listener who is willing to listen to you talk about your hopes and fears. This can be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member, or a support group can also be useful.

Ask your healthcare provider about support groups in your area. You also can search online or check the library. You can find a support group through a national organization, such as the American stroke Association or the Aneurysm and AVM Foundation.

Preparing for your appointment

A brain arteriovenous malformations (AVMS) may be diagnosed in an emergency situation right after the bleeding has occurred. It can also be found after other symptoms symbol of a brain scan.

But sometimes a brain AVM can be found in the diagnosis or treatment of a relationship of medical condition. Then, you may be referred to a specialist trained in brain and nervous system, such as a neurologist or neurosurgeon.

Because there's often a lot to discuss, it is a good idea to get prepared for your appointment. Here are some tips to help you prepare and what to expect from your health care professional.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do beforehand.
  • Write down any symptoms you're experiencing, including any that do not seem to be related to the reason for which you scheduled the appointment.
  • Make a list of all the medicines, vitamins, and supplements you are taking.
  • Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who comes with you may remember something that you've forgotten or lost.
  • Write questions to ask. In addition, do not be afraid to ask questions that may arise during your appointment.

The appointment time is limited, so preparing a list of questions in advance will help to make the most of your time. For brain AVM, some basic questions to ask include:

  • What are other possible causes of the symptoms?
  • What evidence do I need to confirm the diagnosis?
  • What are my treatment options and the advantages and disadvantages of each?
  • What results can I expect?
  • What type of follow-up should I expect?

What to expect from your doctor

Your neurologist is likely to ask you about any symptoms you may be experiencing, do a physical exam and schedule of tests to confirm the diagnosis.

Tests of collecting information on the size and location of the MALFORMATION to help direct your treatment options. Your neurologist may ask:

  • When did the symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

Avoid any activity that may raise your blood pressure and put stress on the brain AVM, such as lifting heavy objects or straining. Also avoid the use of blood-thinning medications, such as warfarin (Jantovin).

Symptoms and treatment of brain AVM (arteriovenous malformation)