Intracranial arteriovenous malformation
Overview
Intracranial arteriovenous malformation: A congenital malformation where there is an opening that connects an artery with a vein inside the brain. Severity of symptoms is determined by the extent of the malformation.
Symptoms
The list of signs and symptoms mentioned in various sources for Intracranial arteriovenous malformation includes the 5 symptoms listed below: * Congestive heart failure in infants * Seizures * Headaches * Bleeding in the brain * Neurological deficits
Causes
Although some AVMs occur as a result of penetrating injuries such as trauma, most are present at birth. However, symptoms typically don’t occur until between the ages 10 and 20. Very large AVMs may short-circuit blood flow enough to cause cardiac decompensation, in which the heart can’t pump enough blood to compensate for bleeding in the brain. This typically occurs in infants and young children. The vessels of an AVM are very thin and one or more arteries feed into it, causing it to appear dilated and tortuous. Typically, high-pressured arterial flow moves into the venous system through the connecting channels to increase venous pressure, engorging and dilating the venous structures. If the AVM is large enough, the shunting can deprive the surrounding tissue of adequate blood flow. Thin-walled vessels may ooze small amounts of blood — they may even rupture — causing hemorrhage into the brain or subarachnoid space. Cerebral arteriovenous malformations occur in approximately 3 out of 10,000 people. Although the lesion is present at birth, symptoms may occur at any time. Two-thirds of cases occur before age 40. Evidence suggests that AVMs run in families. Males and females are affected equally.
Diagnosis
Home medical testing related to Intracranial arteriovenous malformation: * High Blood Pressure: Home Testing o Home Blood Pressure Tests o Home Blood Pressure Monitors o Home Heart Tests * Heart Health: Home Testing: o Heart Rate Monitors o Irregular Heartbeat Detection o Heart Electrocardiogram (
Treatment
General support measures include aneurysm precautions to prevent possible rupture. This involves placing the patient on bed rest or with limited activity and maintaining a quiet atmosphere. Analgesics may be given for headache, and sedatives may be given to help calm the patient and prevent rupture. Stool softeners may be given to prevent straining at stool, which increases intracranial pressure. A bleeding AVM is a medical emergency requiring immediate hospitalization. The goal of treatment is to prevent further complications by limiting bleeding, controlling seizures and, if possible, removing the AVM. Surgery for correction may include block dissection, laser, or ligation to repair the communicating channels and remove the feeding vessels. Embolization or radiation therapy may be done, if surgery isn’t possible, to close the communicating channels and feeder vessels, thereby reducing blood flow to the AVM. Open brain surgery, endovascular treatment, and radiosurgery may be used separately or in any combination, depending upon the physician and the patient’s individual situation. Surgery is dependent upon the accessibility and size of the lesion and the patient’s status. Open brain surgery involves the actual removal of the malformation in the brain through an opening made in the skull. This surgery is particularly risky because the surgery itself may cause the AVM to bleed uncontrollably. Embolization (injecting a gluelike substance into the abnormal vessels to stop aberrant blood flow into the AVM) may be an alternative if surgery isn’t feasible due to the size or location of the lesion. Stereotactic radiosurgery may also be an alternative for patients with inoperable arteriovenous malformations. It’s particularly useful for small, deep lesions, which are difficult to remove by surgery. Anticonvulsant medications such as phenytoin are usually prescribed if seizures occur.