Cerebral arteriovenous malformations (AVMs) are uncommon vascular lesions that can manifest with spontaneous intracranial hemorrhage Intracerebral Hemorrhage Intracerebral hemorrhage is focal bleeding from a blood vessel in the brain parenchyma. The cause is usually hypertension. Typical symptoms include focal neurologic deficits, often with abrupt... read more , seizures, or headache, typically in young adults.
Hemorrhage due to a brain AVM is typically intraparenchymal but can be subarachnoid Subarachnoid Hemorrhage (SAH) Subarachnoid hemorrhage is sudden bleeding into the subarachnoid space. The most common cause of spontaneous bleeding is a ruptured aneurysm. Symptoms include sudden, severe headache, usually... read more or intraventricular.
Seizures are typically focal, and the location of the AVM determines the seizure type. These focal seizures often become generalized.
Cerebral AVMs can also manifest with headache, even without intracranial hemorrhage. Occasionally, a cranial bruit can be detected.
Diagnosis of Cerebral AVMs
Contrast or noncontrast CT, MRI, CT angiography, or magnetic resonance angiography can often detect AVMs. Digital subtraction angiography, often considered the gold standard, is done to confirm the diagnosis and to help plan treatment.
Unruptured AVMs are often incidental findings when neuroimaging is done for other reasons.
Treatment of Cerebral AVMs
Microsurgery, radiosurgery, and/or endovascular surgery
For cerebral arteriovenous malformations, the primary goal of treatment is to prevent hemorrhagic stroke. The risks of various treatments must be weighed against the risks of the AVM's natural history (1 Treatment reference Arteriovenous malformation (AVMs) are tangled, dilated blood vessels in which arteries flow directly into veins. AVMs occur most often at the junction of cerebral arteries, usually within the... read more ).
One treatment option is conservative management for patients who are deemed to have a low risk of bleeding or a high risk of adverse effects from treatment. These risks are based on the location of the AVM, symptoms, and overall health status of the patient.
Interventional treatment options include microsurgical resection, stereotactic radiosurgery, endovascular embolization, or combinations of these (multimodal therapy).
Patients who have had a ruptured AVM are at increased risk of further hemorrhage and are usually treated with an interventional option.
1. Derdeyn CP, Zipfel GJ, Albuquerque FC, et al: Management of brain arteriovenous malformations: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 48(8):e200–e224, 2017. doi: 10.1161/STR.0000000000000134