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Cerebral Arteriovenous Malformation
Aka: Cerebral Arteriovenous Malformation, Cerebral AV Malformation, Cerebral AVM, Arteriovenous Malformation of the Brain, BAVM, Brain Arteriovenous Malformation, Brain AV Malformation
- See Also
- Arteriovenous Malformation
- Intracerebral Hemorrhage
- Definitions
- Cerebral Arteriovenous Malformation
- AV Malformations (AVMs) are abnormal direct connections between arteries and veins, bypassing capillaries
- AVMs Results in dilated arteries at risk of bleeding, in this case in the brain resulting in Intracerebral Hemorrhage
- Epidemiology
- Prevalence (unruptured and ruptured): 10 to 18 per 100,000 adults
- Findings: Presentations
- Asymptomatic in 85% of patients
- Intracranial Hemorrhage (>40% of cases, esp. children)
- Represents 10% of Intracranial Hemorrhage cases
- Intracerebral Hemorrhage is most common, but Subarachnoid Hemorrhage may occur
- Seizure (>15% of cases)
- More common in large or multiple, superficial lesions
- Symptoms
- Headache
- Neurologic deficits
- Imaging
- CT Head
- Performed in acute presentation suspicious for Intracranial Hemorrhage
- However, low Test Sensitivity for AV Malformation
- CT Angiogram Brain
- "Bag of Worm" appearance of tortuous, dilated arteries to nidus and draining vein
- MRI Brain (preferred)
- T2 Weighted images are most sensitive at identifying flow voids in the region of AV Malformation
- Grading: Spetzler-Martin
- Nidus Size
- Score 1: <3 cm
- Score 2: 3-6 cm
- Score 3: >6 cm
- Importance (Eloquence) of Adjacent Brain Regions at Risk (score one point for any of the following)
- Brainstem
- Cerebellar Peduncles
- Thalamus
- Hypothalamus
- Language centers
- Sensorimotor centers
- Primary visual cortex
- Venous Drainage (score one point for venous drainage to deep veins )
- Basal veins
- Internal cerebral veins
- Precentral cerebellar veins
- Differential Diagnosis
- See Intracerebral Hemorrhage
- See Seizure Causes
- See Headache Causes
- Cerebrovascular Accident
- Cerebral Venous Thrombosis
- Migraine Headache
- Cervical Artery Dissection
- Cerebral Aneurysm
- Other vascular disorders (e.g. Fibromuscular Dysplasia)
- Management
- Consult Neurosurgery
- Surgical Intervention
- Indications
- Young patients with at least one high risk feature for Intracranial Hemorrhage
- Refractory Seizures
- Primary Procedures
- Open microsurgical excision
- Adjunctive or Alternative Procedures
- Radiotherapy
- Endovascular embolization
- Medical management
- Seizure Prophylaxis
- Headache Management
- Complications
- Intracranial Hemorrhage
- Seizure Disorder
- Intracranial Mass Effect
- Progressive neurologic deficits
- References
- Bokhari (2021) Arteriovenous Malformation of the Brain, Stat Pearls, Treasure Island, accessed 3/30/2022
- https://www.ncbi.nlm.nih.gov/books/NBK430744/
- Derdeyn (2017) Stroke 48:e200-24 +PMID:28642352 [PubMed]