From the Guidelines
Arteriovenous malformation (AVM) symptoms can be severe and life-threatening, and patients with suspected AVM should seek immediate medical attention if they experience sudden, severe headache, weakness, numbness, vision changes, or seizures. AVM symptoms vary widely depending on the location and size of the abnormal blood vessel tangle [ 1 ]. Common symptoms include:
- Severe headaches
- Seizures, which occur in 20% to 25% of cases [ 1 ]
- Muscle weakness
- Numbness
- Vision problems
- Difficulty speaking
- Confusion
- Coordination issues
- Pulsating sound in the ears (tinnitus)
- Dizziness
- Nausea
In severe cases, AVMs can rupture and cause bleeding in the brain (hemorrhage), leading to sudden, severe headache, loss of consciousness, paralysis, or even death [ 1 ]. The risk of hemorrhage is approximately 2-4% per year, with each bleeding event carrying significant mortality and morbidity risks [ 1 ]. Not all AVMs cause symptoms; some are discovered incidentally during brain imaging for other conditions. Symptoms typically develop between ages 10 and 40 as the malformation grows and puts pressure on surrounding tissues or when blood flow is diverted from normal brain tissue (steal phenomenon) [ 1 ].
The diagnosis of AVM is typically made using a combination of MRI and angiography, with arteriography being the "gold standard" for defining the arterial and venous anatomy [ 1 ]. It is strongly recommended that an MRI study and a 4-vessel angiogram be obtained to delineate the anatomy of an AVM [ 1 ]. The management of AVMs requires a multidisciplinary approach, and treatment options may include surgery, embolization, or radiosurgery [ 1 ].
From the Research
Arteriovenous Malformation Symptoms
- Symptoms of arteriovenous malformations (AVMs) can include bleeding, skin ulceration, and cardiac failure 2
- AVMs can also cause acute or chronic neurological symptoms, such as deficits, seizures, or headache 3
- In some cases, AVMs may be asymptomatic and discovered incidentally 3, 4
- The risk of developing neurological symptoms from an AVM increases with patient age 3
- Intracranial hemorrhage is a common presentation of AVMs, and can be a life-threatening complication 3, 5, 4
Diagnosis and Evaluation
- Doppler ultrasound is often the first imaging examination performed to evaluate AVMs 2
- MR angiography or computed tomography angiography (CTA) may also be used to evaluate AVMs, depending on the anatomic area involved 2
- Digital subtraction angiography (DSA) is used to guide embolization and to classify AVMs according to their anatomy 2, 6
- The Schobinger clinical classification is used to assess patient evolution and indicate intervention 2
Treatment Options
- Embolization is currently the first line of treatment for AVMs, and can be used to reduce the size of the malformation or to target high-risk features 2, 6
- Surgery may be indicated to resect residual AVM following embolization, if residual symptoms are present and the planned surgery is feasible 2
- Radiosurgery is also a treatment option for AVMs, particularly for those that are centrally located or have a small nidus volume 3, 4
- Observation may be recommended for some patients with unruptured AVMs, as the natural history of these lesions may be less morbid than invasive therapies 5, 4