CV

Cerebral Arteriovenous Malformation

search

Cerebral Arteriovenous Malformation, Cerebral AV Malformation, Cerebral AVM, Arteriovenous Malformation of the Brain, BAVM, Brain Arteriovenous Malformation, Brain AV Malformation

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