Arteriovenous malformation (AVM)

Arteriovenous malformation (AVM) is a condition characterized by abnormal tangled connections between arteries and veins, muck like tangled wires behind a television. These abnormal connections result in direct pathways between arteries and veins, which can potentially lead to serious complications such as strokes.

A stroke is a medical emergency that requires immediate attention. If you or someone you know is displaying symptoms of a stroke, call 911.

Arteriovenous malformation symptoms

The symptoms of arteriovenous malformation (AVM) can vary depending on its location and size. Interestingly, some individuals may not experience any symptoms, particularly during their younger years. Typically, symptoms tend to emerge around the mid-30s.

During pregnancy, symptoms may arise or worsen due to increases in blood volume and blood pressure.

Common symptoms associated with AVM include:

• Confusion, hallucinations or dementia
• Headaches
• Memory, vision or speech problems
• Seizures
• Weakness or paralysis on one side of the body

It's noteworthy that for many individuals with AVM, the occurrence of a hemorrhage serves as their initial indication of the condition.

Arteriovenous malformation complications

The greatest risk from an AVM is severe bleeding that leads to a stroke. However, an AVM can lead to other potential complications, such as:

• Brain damage
• Bleeding in the brain
• Thin or weak blood vessels
• Reduced oxygen to the brain

Diagnosing an arteriovenous malformation

Obtaining a diagnosis for an AVM typically involves a thorough evaluation by your provider. This process includes:

• Physical exam: Your doctor will conduct a physical examination and inquire about any symptoms you may be experiencing. They will also review your medical history and listen to your heart.
• Stethoscope exam: Some AVMs produce a distinctive noise that can be detected by your doctor using a stethoscope.
• Imaging tests: Your healthcare provider may order imaging tests such as a CT scan or MRI to obtain detailed images of the blood vessels in your spine, neck, and head. These imaging techniques help in visualizing the structure and potential abnormalities associated with an AVM.
• Cerebral angiogram: In some cases, more advanced testing options like a cerebral angiogram may be necessary. During this procedure, a catheter is inserted into your neck or head to release a dye that highlights any malformations in the blood vessels, providing a clearer understanding of the AVM characteristics and location.

Arteriovenous malformation treatment

Treatment options for an AVM vary depending on several factors. Before deciding on a treatment approach, your doctor will evaluate the risks of possible hemorrhage against the risks associated with treatment, particularly if the AVM has not ruptured.

Factors contributing to the risk of hemorrhage may include:

• Pregnancy
• AVM location and size
• AVM symptoms
• Your age and overall health

Your doctor may prescribe medications to alleviate symptoms such as seizures and headaches associated with AVM.

Surgical treatments for AVMs

Surgical intervention may be necessary in some cases. Surgical options include:

• CyberKnife® radiosurgery: This non-invasive technique employs beams of radiation to target small, unruptured AVMs. Over several months, the radiation causes the blood vessels to degrade and close off.
• Endovascular embolization: This minimally invasive procedure involves inserting a catheter into a blood vessel and guiding it to the AVM. A substance such as glue is then injected to block off the abnormal blood vessels. Endovascular embolization is often performed prior to microsurgery for AVM removal.
• Microsurgery: Microsurgery entails removing a portion of the skull and using a surgical microscope and specialized tools to remove the AVM.

Following treatment, especially in cases of a ruptured AVM, rehabilitation may be necessary to aid patients in regaining lost function and recovering from any neurological deficits resulting from the AVM or its treatment. Rehabilitation may include physical therapy, occupational therapy or speech therapy.

Your healthcare provider will work closely with you to determine the most appropriate treatment approach based on your individual circumstances and preferences.