From the Guidelines
Brain arteriovenous malformations (AVMs) are associated with several serious neurological conditions, most commonly hemorrhagic stroke, which occurs when these abnormal blood vessel tangles rupture, causing bleeding in the brain, as well as seizures, chronic headaches, progressive neurological deficits, hydrocephalus, cognitive impairments, and in rare cases, heart failure due to high-flow shunting of blood 1.
Associated Conditions
The diseases associated with brain AVMs include:
- Hemorrhagic stroke: The most common disease linked to brain AVMs, occurring when the abnormal blood vessel tangles rupture, causing bleeding in the brain 1.
- Seizures: Affecting approximately 20-40% of patients with brain AVMs 1.
- Chronic headaches: Ranging from mild to severe and may mimic migraines 1.
- Progressive neurological deficits: Developing as AVMs steal blood from surrounding brain tissue or exert pressure on adjacent neural structures 1.
- Hydrocephalus: Occurring when AVMs obstruct cerebrospinal fluid circulation 1.
- Cognitive impairments: Particularly when AVMs are located in regions responsible for higher brain functions 1.
- Heart failure: In rare cases, due to the high-flow shunting of blood 1.
Risk Factors
The risk of hemorrhage from a brain AVM is estimated to be 2-4% per year, with a higher risk in patients with previously ruptured AVMs 1. The annual rupture risk of a brain AVM is 1.3% for previously unruptured AVM and up to 4.8% for previously ruptured lesions 1.
Treatment
Treatment for AVMs includes surgical resection, endovascular embolization, stereotactic radiosurgery, or medical management, with the ARUBA trial concluding that medical management alone was superior to medical management with interventional therapy for the prevention of death or stroke in patients with unruptured brain AVMs 1.
From the Research
Diseases Associated with Arteriovenous (AV) Malformations of the Brain
The following diseases and conditions are associated with AV malformations of the brain:
- Hemorrhagic stroke: AV malformations can cause hemorrhagic stroke, which is a severe complication 2
- Epilepsy: AV malformations can cause epilepsy, with an overall annual rate of 1% for the risk of epilepsy 3
- Chronic headache: AV malformations can cause chronic headache 2
- Focal neurologic deficits: AV malformations can cause focal neurologic deficits 2
- Psychologic burden: The natural history of an AV malformation also encompasses the daily psychologic burden that a patient must endure knowing that he or she possesses an untreated AV malformation 3
Risk Factors for AV Malformation Hemorrhage
The following risk factors are associated with AV malformation hemorrhage:
- Deep location: Deep location of the AV malformation is a significant risk factor for hemorrhage 3
- Deep venous drainage: Deep venous drainage is a significant risk factor for hemorrhage 3
- Associated aneurysms: Associated aneurysms are a significant risk factor for hemorrhage 3
- Pregnancy: Pregnancy is a significant risk factor for hemorrhage 3
- Previous hemorrhage: Previous hemorrhage is a significant risk factor for rebleed, with a rebleed rate ranging from 6% to 15.8% in the first year after rupture 3