| Characterized by headaches and seizures, an | | | | hemisphere of the brain. |
| arteriovenous malformation (AVM) of the brain is a | | | | |
| derivative of arteriovenous malformation, a disorder | | | | How is an AVM of the brain diagnosed? |
| of the body’s circulatory system. An AVM of | | | | |
| the brain, also known as a cerebral AVM, is a | | | | Brain AVMs can be diagnosed using a few methods, |
| malformed group of blood vessels composed of an | | | | with the most non-invasive techniques being CT and |
| intricate tangle of arteries and veins. Though localized, | | | | MRI scans. Both scans reveal lesions while CT scans |
| cerebral AVMs can lead to severe neurological | | | | are particularly helpful in showing hemorrhaging. Three |
| problems. Research in the field of arteriovenous | | | | dimensional representations of cerebral AVMs can be |
| malformation is growing particularly with noninvasive | | | | detected by CT and MRI imaging. |
| treatment options. | | | | |
| | | | | A more intricate process in identifying an AVM of the |
| What are cerebral AVMs? | | | | brain involves angiography. A contrast agent, or |
| | | | | water-soluble dye, is injected into the brain allowing |
| Cerebral AVMs may form during prenatal stages of a | | | | an x-ray to deliver more precise images that highlight |
| child’s development, either during embryonic or | | | | blood vessel structure. This procedure carries the risk |
| fetal growth. Studies have found a certain number of | | | | of causing a stroke, but more research has led to |
| cases form shortly after birth; however, the | | | | vast improvements with angiography thereby |
| condition frequently presents in adults in their 20s or | | | | reducing stroke potential. |
| 30s. Cerebral AVMs are commonly misdiagnosed, with | | | | |
| most cases found only incidentally through the | | | | What treatment options are available? |
| performance of CT (computed tomography) scans | | | | |
| on the brain. Patients complain of regular headaches | | | | Endovascular embolization is growing in popularity as a |
| and seizures before diagnosis. | | | | non-invasive treatment option for patients with |
| | | | | cerebral AVMs. Dr. Alejandro Berenstein, the director |
| Other neurological complications can develop including | | | | of Beth Israel's Hyman-Newman Institute for |
| speech and visual difficulty, dizziness, memory | | | | Neurology and Neurosurgery (INN) at Roosevelt |
| deficits, confusion, hallucinations, dementia and | | | | Hospital in New York City, is a pioneer in the field of |
| difficulty with event planning. Physical side effects | | | | endovascular embolization. Using research-driven |
| range from loss of coordination, numbness, tingling | | | | methods, Dr. Berenstein performs embolization prior |
| and spontaneous pain to permanent paralysis. | | | | to surgery reducing the risk of complications. |
| Patients’ symptoms are directly associated with | | | | |
| the location of the cerebral AVM with certain sites | | | | Endovascular embolization involves guiding a catheter |
| causing hydrocephalus. Hydrocephalus is caused by a | | | | through the arterial pathway into the site of the |
| cerebral AVM preventing the circulation of | | | | AVM. A substance is injected into the site reducing |
| cerebrospinal fluid thereby causing fluid build-up in the | | | | the blood flow through the lesion. Blood flow |
| skull. | | | | reduction is a proven method in making surgery a |
| | | | | safer process for patients. |
| What are the potential health consequences of | | | | |
| cerebral AVMs? | | | | Conventional surgery follows endovascular |
| | | | | embolization whereby the central portion of the AVM |
| Hemorrhaging is the most common side effect of | | | | is completely removed causing minimal to no invasion |
| patients experiencing cerebral AVM. The size and | | | | of surrounding neurological structures. Deeply situated |
| location of the cerebral AVM determines the | | | | lesions typically are not considered for conventional |
| patient’s likelihood of experiencing hemorrhaging. | | | | surgery. However, experts in endovascular |
| Research has found between 2 and 4 percent of all | | | | embolization such as Dr. Berenstein are finding |
| AVMs to hemorrhage each year with most episodes | | | | significant success in reaching deeper AVMs, which |
| going undetected. Minor hemorrhaging does not cause | | | | can be followed by conventional surgery. In this case, |
| neurological damage, hence the reason patients and | | | | the risk of mortality and complications are further |
| doctors remain unaware it takes place. On the other | | | | reduced. |
| hand, massive hemorrhaging has been documented | | | | |
| with some cases being fatal. Once a cerebral AVM | | | | Radiosurgery is another option for patients with |
| bleeds, the risk of hemmorahaging again within the | | | | localized lesions. Radiosurgery involves targeting the |
| next year is nine times as likely. Though research has | | | | center of the lesion with a radiation beam damaging |
| grown extensively, doctors are still unable to predict | | | | the blood vessel walls. Over several months following |
| whether a patient with cerebral AVM will or will not | | | | radiation treatment, the vessels begin to degenerate |
| experience hemorrhaging. | | | | and ultimately close. |
| | | | | |
| While there is no definitive research, doctors have | | | | The method of surgery performed is thoroughly |
| found certain cases to have a higher likelihood of | | | | evaluated with each surgeon identifying the best |
| causing bleeding. Though it may seem contradictory, | | | | option on a case-by-case basis. Left untreated, |
| smaller AVMs have a greater chance of hemorrhaging | | | | cerebral AVMs can cause severe hemorrhaging, which |
| than larger ones. Increased blood pressure and blood | | | | may lead to serious complications or death. |
| volume from being pregnant also increases a | | | | |
| patient’s potential for bleeding. Lastly, deeply | | | | What is the outlook/prognosis for patients after |
| situated AVMs with extremely narrow veins impair | | | | treatment? |
| proper drainage leading to an increased risk for | | | | |
| hemorrhaging. | | | | Embolization and radiation therapy often lead to |
| | | | | temporary results. When a cerebral AVM is large, |
| Once again, the location of the hemorrhaging AVM is | | | | radiosurgery takes months to heal leaving the patient |
| directly proportionate to the side effects of | | | | still at risk for hemorrhaging. |
| hemorrhaging. Bleeding AVMs situated deep within | | | | |
| the brain, called intracerebral or parenchymal cerebral | | | | Research in the field has found endovascular |
| hemorrhage, cause the most damage. | | | | embolization coupled with either conventional surgery |
| | | | | or radiation therapy to have the best results. The risk |
| In addition to brain hemorrhaging, AVMs on their own | | | | of complication or death is minimized with duel |
| can inflict harsh brain and spinal dysfunctions. Patients | | | | therapy treatments. |
| who experience severe side effects are typically | | | | |
| victims of one of three problems. Aside from | | | | Disclaimer: This article is for informational purposes |
| hemorrhaging, AVMs reduce oxygen reaching | | | | and should not be considered a substitute for |
| neurological tissues and compress and displace parts | | | | professional medical advice, diagnosis, or treatment. |
| of the brain. The larger the lesion, the greater chance | | | | Always seek the advice of your physician or other |
| of the latter problem occurring with certain AVMs | | | | qualified health provider with any question you may |
| reaching up to 2.5 inches in diameter. Certain lesions | | | | have regarding a medical condition. |
| have been documented to distort an entire | | | | |