Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Arteriovenous Malformations Clinical Presentation

  • Author: Souvik Sen, MD, MPH, MS, FAHA; Chief Editor: Helmi L Lutsep, MD  more...
 
Updated: Mar 27, 2014
 

History

See the list below:

  • AVMs tend to be clinically silent until the presenting event occurs. Therefore, the diagnosis usually is made at the time of the first seizure or hemorrhage.
  • A history of minor learning disability is present in as many as two thirds of patients; such dysfunction is rarely apparent in adult life.
  • A history of headaches is present in as many as half of patients with cerebral AVM. The headaches subsequently may take the form of classic migraine or more generalized headache.
  • If seizures have occurred, a careful seizure history should be obtained. Seizures are simple, partial, or secondarily generalized.
  • The effectiveness of anticonvulsant therapy should be observed carefully and monitored before and during treatment.
Next

Physical

See the list below:

  • Focal neurologic findings are rare in the absence of seizure or hemorrhage in patients with cerebral AVMs. They are more common in brainstem and deeply located AVMs. They are associated with patient’s age and are more common among women.
  • Detailed neuropsychological testing may disclose subtle right or left hemisphere dysfunction.
  • If parenchymal hemorrhage is present, the physical findings are indistinguishable from those due to intracranial hemorrhage of other causes.
  • Intraventricular hemorrhage generally produces a less severe neurological deficit than hemorrhage into other areas of the brain.
  • In the rare patients in whom focal neurological deficits are present, the deficit may reflect the location of the AVM.
Previous
Next

Causes

See the list below:

  • No genetic, demographic, or environmental risk factors for cerebral AVM have been identified clearly.
  • Families with cerebral AVMs are rare, and such pedigrees have been too small to enable linkage studies. From the few family cases reported, the inheritance appears to be autosomal dominant.
  • In a small minority of cases, cerebral AVMs are associated with other inherited disorders, such as the Osler-Weber-Rendu syndrome (ie, hereditary hemorrhagic telangiectasia), Sturge-Weber disease, neurofibromatosis, and von Hippel-Lindau syndrome.
Previous
 
 
Contributor Information and Disclosures
Author

Souvik Sen, MD, MPH, MS, FAHA Professor and Chair, Department of Neurology, University of South Carolina School of Medicine

Souvik Sen, MD, MPH, MS, FAHA is a member of the following medical societies: American Academy of Neurology, Association for Patient-Oriented Research, American Heart Association

Disclosure: Nothing to disclose.

Coauthor(s)

James Selph, MD Assistant Professor of Neurology, University of South Carolina School of Medicine; Director of Neurophysiology Lab and Services, Palmetto Richland Hospital

James Selph, MD is a member of the following medical societies: American Association of Neuromuscular and Electrodiagnostic Medicine, American Epilepsy Society

Disclosure: Nothing to disclose.

Sharon W Webb, MD Assistant Professor of Clinical Neurosurgery, University of South Carolina School of Medicine

Sharon W Webb, MD is a member of the following medical societies: American Association of Neurological Surgeons, Congress of Neurological Surgeons, Neurocritical Care Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Howard S Kirshner, MD Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Neurological Association, American Society of Neurorehabilitation, American Academy of Neurology, American Heart Association, American Medical Association, National Stroke Association, Phi Beta Kappa, Tennessee Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.

Additional Contributors

Edward L Hogan, MD Professor, Department of Neurology, Medical College of Georgia; Emeritus Professor and Chair, Department of Neurology, Medical University of South Carolina

Edward L Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, Society for Neuroscience, American Society for Biochemistry and Molecular Biology, American Academy of Neurology, American Neurological Association, Phi Beta Kappa, Sigma Xi, Southern Clinical Neurological Society

Disclosure: Nothing to disclose.

References
  1. Guo YH, Chen HX, Xie RM. [Effects of qi-supplementing dominated Chinese materia medica combined with rehabilitation training on the quality of life of ischemic post-stroke fatigue patients of qi deficiency syndrome]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2012 Feb. 32(2):160-3. [Medline].

  2. [Guideline] Ogilvy CS, Stieg PE, Awad I, Brown RD Jr, Kondziolka D, Rosenwasser R. AHA Scientific Statement: Recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association. Stroke. 2001 Jun. 32(6):1458-71. [Medline].

  3. Weinsheimer S, Kim H, Pawlikowska L, Chen Y, Lawton MT, Sidney S, et al. EPHB4 gene polymorphisms and risk of intracranial hemorrhage in patients with brain arteriovenous malformations. Circ Cardiovasc Genet. 2009 Oct. 2(5):476-82. [Medline].

  4. Laakso A, Dashti R, Juvela S, Niemelä M, Hernesniemi J. Natural history of arteriovenous malformations: presentation, risk of hemorrhage and mortality. Acta Neurochir Suppl. 2010. 107:65-9. [Medline].

  5. Stapf C, Mast H, Sciacca RR, Berenstein A, Nelson PK, Gobin YP, et al. The New York Islands AVM Study: design, study progress, and initial results. Stroke. 2003 May. 34(5):e29-33. [Medline].

  6. Mast H, Young WL, Koennecke HC. Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet. 1997 Oct 11. 350(9084):1065-8. [Medline].

  7. Halim AX, Johnston SC, Singh V. Longitudinal risk of intracranial hemorrhage in patients with arteriovenous malformation of the brain within a defined population. Stroke. 2004 Jul. 35(7):1697-702. [Medline].

  8. Park SH, Hwang SK. Transcranial Doppler study of cerebral arteriovenous malformations after gamma knife radiosurgery. J Clin Neurosci. March 2009. 16(3):378-384.

  9. ARUBA Investigators. Unruptured brain arteriovenous malformation trial. [The Internet Stroke Center]. Feb 2006. [Full Text].

  10. ARUBA Study. Unruptured brain arteriovenous malformation trial. [ARUBA Study Site]. Feb 2006. [Full Text].

  11. Lawton MT, Kim H, McCulloch CE, Mikhak B, Young WL. A Supplementary Grading Scale for Selecting Patients With Brain Arteriovenous Malformations for Surgery. Neurosurgery. 2010. 66(4):702-713.

  12. Hernesniemi J, Romani R, Lehecka M, Isarakul P, Dashti R, Celik O, et al. Present state of microneurosurgery of cerebral arteriovenous malformations. Acta Neurochir Suppl. 2010. 107:71-6. [Medline].

  13. Sahlein DH, Mora P, Becske T, Nelson PK. Nidal embolization of brain arteriovenous malformations: rates of cure, partial embolization, and clinical outcome. J Neurosurg. 2012 Apr 27. [Medline].

  14. Parkhutik V, Lago A, Tembl JI, et al. Postradiosurgery hemorrhage rates of arteriovenous malformations of the brain: influencing factors and evolution with time. Stroke. 2012 May. 43(5):1247-52. [Medline].

  15. Kano H, Kondziolka D, Flickinger JC, et al. Stereotactic radiosurgery for arteriovenous malformations after embolization: a case-control study. J Neurosurg. 2012 May 25. [Medline].

  16. Sheehan J. Radiosurgery. J Neurosurg. 2012 Jan. 116(1):1-2; discussion 9-10. [Medline].

  17. Castel JP, Kantor G. [Postoperative morbidity and mortality after microsurgical exclusion of cerebral arteriovenous malformations. Current data and analysis of recent literature]. Neurochirurgie. 2001 May. 47(2-3 Pt 2):369-83. [Medline].

  18. Al-Shahi R, Bhattacharya JJ, Currie DG, Papanastassiou V, Ritchie V, Roberts RC, et al. Prospective, population-based detection of intracranial vascular malformations in adults: the Scottish Intracranial Vascular Malformation Study (SIVMS). Stroke. 2003 May. 34(5):1163-9. [Medline].

  19. ApSimon HT, Reef H, Phadke RV, Popovic EA. A population-based study of brain arteriovenous malformation: long-term treatment outcomes. Stroke. 2002 Dec. 33(12):2794-800. [Medline].

  20. Boggs W. Stereotactic Brain Radiosurgery Helps Small Unruptured Arteriovenous Malformations. Medscape Medical News. Jan 08 2013. [Full Text].

  21. Flickinger JC, Kondziolka D, Lunsford LD, Pollock BE, Yamamoto M, Gorman DA. A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys. 1999 Apr 1. 44(1):67-74. [Medline].

  22. Hartmann A, Mast H, Mohr JP, Pile-Spellman J, Connolly ES, Sciacca RR. Determinants of staged endovascular and surgical treatment outcome of brain arteriovenous malformations. Stroke. 2005 Nov. 36(11):2431-5. [Medline]. [Full Text].

  23. Hillman J. Population-based analysis of arteriovenous malformation treatment. J Neurosurg. 2001 Oct. 95(4):633-7. [Medline].

  24. Hofmeister C, Stapf C, Hartmann A, et al. Demographic, morphological, and clinical characteristics of 1289 patients with brain arteriovenous malformation. Stroke. 2000 Jun. 31(6):1307-10. [Medline]. [Full Text].

  25. Maruyama K, Kawahara N, Shin M. The risk of hemorrhage after radiosurgery for cerebral arteriovenous malformations. N Engl J Med. 2005 Jan 13. 352(2):146-53. [Medline].

  26. Nataf F, Ghossoub M, Schlienger M. Bleeding after radiosurgery for cerebral arteriovenous malformations. Neurosurgery. 2004 Aug. 55(2):298-305; discussion 305-6. [Medline].

  27. Pollock BE, Link MJ, Brown RD. The Risk of Stroke or Clinical Impairment After Stereotactic Radiosurgery for ARUBA-Eligible Patients. Stroke. 2013 Jan 3. [Medline].

Previous
Next
 
Axial T2 MRI showing an arteriovenous malformation with hemorrhage, in the territory of the left posterior cerebral artery.
T1 axial MRI showing a small subcortical arteriovenous malformation in the right frontal lobe.
T2 coronal MRI showing an arteriovenous malformation in the left medial temporal lobe.
Magnetic resonance angiography showing a left medial temporal arteriovenous malformation.
Angiogram (anteroposterior view) showing an arteriovenous malformation in the deep left middle cerebral artery territory measuring approximately 3 cm in diameter, with a deep draining vein (arrow).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.