What is brain AVM?

When aberrant blood vessels, which connect arteries and veins, tangle in the brain, it leads to a brain arteriovenous malformation, or AVM. The critical functions of the arteries carrying oxygen-rich blood from the heart to the brain and the veins returning oxygen-depleted blood to the heart and lungs are disrupted by a brain AVM.

Arteriovenous malformations can be found anywhere in the body. However, it is more likely to be found in the brain and spine. The origin of AVMs is not known. Most people are born with them, but it is also possible that they can develop later in life. They can be inherited, though this is rare.

Seizures, brain damage, and stroke may be serious side effects of an AVM if left untreated. A brain AVM is generally treatable after diagnosis to prevent these complications.

What are the symptoms of brain AVM?

A brain arteriovenous malformation may not show any symptoms until it bursts. This will result in a haemorrhage, which is bleeding in the brain.

Other signs of a brain AVM include:

• A seizure
• A headache or pain in one section of the head
• A weakening or numbness in a body component

What causes brain arteriovenous malformation (AVM)?

There are no known causes for brain AVMs. According to scientists, most brain AVMs occur by birth and develop as the fetus grows in the womb. Brain AVMs can develop at any age.

Some people affected by hereditary hemorrhagic telangiectasia have brain AVMs. Osler-Weber-Rendu syndrome is another term for hereditary hemorrhagic telangiectasia. The development of blood vessels in the brain and the rest of the body is related to hereditary hemorrhagic telangiectasia.

Usually, the oxygen-rich blood that flows from the heart into the brain is carried by the arteries. Arteries limit blood flow by channeling it through a series of ever smaller blood vessels. Capillaries are the smallest blood vessels. Oxygen seeps into the surrounding brain tissue gradually through the thin, porous walls of the capilleries.

The blood which has lost its oxygen is conveyed through tiny blood arteries before going into bigger veins. The veins carry the blood back to the heart and lungs for more oxygen.

This supporting system of tiny blood vessels and capillaries is lacking in the arteries and veins of an AVM. Instead, blood flows directly and rapidly from the arteries to the veins. This deprives the surrounding brain tissue of the oxygen it needs.

How does brain arteriovenous malformation affect my body?

Although cerebral AVMs can be present in any individual at birth, the following variables increase the risk of its occurrence:

• Gender: Brain AVMs are more likely to occur in men.
• Familial history: Some cases of brain AVMs tend to run in families, but it is unknown whether there is a specific genetic predisposition. Inheritance of other medical diseases, for example, hereditary hemorrhagic telangiectasia (HHT), can increase the risk of brain AVMs.

What are the complications of brain arteriovenous malformations?

In case there is a brain arteriovenous malformation or AVM, it may lead to the following complications:

• The brain starts bleeding: The walls of the involved arteries and veins become greatly subjected to pressure when a brain AVM occurs. The veins and arteries weaken or thin as a result of the pressure. This might bring about a haemorrhage, in which the AVM bursts open and spills blood into the brain.

The yearly risk of hemorrhage in the brain AVM is between 2% and 3%. Some types of AVM might be more sensitive to bleeding. Those who have had a bleed from a brain AVM might also be at increased risk.

Even though research has not demonstrated that pregnancy increases the risk of hemorrhage for someone with a brain AVM, further study is needed.

Some haemorrhages associated with brain AVMs are not detected because they do not present any noticeable symptoms. However, potentially dangerous bleeding can occur.

About 2% of all hemorrhagic strokes that occur yearly are caused by brain AVMs. Brain AVMs are often the cause of brain haemorrhage in children and young adults.

• Decreased oxygen supply to the brain: This leads to decreased oxygen supply to the brain. In a brain AVM, it prevents blood from passing through a system of teeny blood vessels called capillaries. Rather, it runs straight from the veins to arteries. Because its smaller blood arteries do not make it slow it down, it rushes through swift.

The fast-moving blood makes it hard for the surrounding brain tissue to absorb oxygen. Brain tissues deteriorate or even die out if there is insufficient oxygen present. This causes symptoms similar to a stroke, like difficulty speaking, weakness, numbness, or vision loss.

• Weak or thin blood vessels: The weak and thin walls of the blood artery are subjected to tremendous strain from an AVM. An aneurysm, which is a bulge in the walls of blood vessels, may occur. It is possible that the aneurysm will rupture.
• Damage to the brain: To get blood to the fast-growing brain AVM, the body may require more arteries to be used. Consequently, the AVM might grow and squish or move parts of the brain. This could prevent fluids that protect the brain from freely flowing.

Fluid accumulation may push brain tissue into the skull.

Babies experience severe complications associated with one form of brain AVM that involves the vein of Galen, an important blood vessel. Symptoms may begin at birth or appear shortly after birth. With this form of brain AVM, the brain becomes swollen, and fluid within the skull occurs. Seizure and scalp veins are dilated. Children with this form of brain AVM may suffer from congestive heart failure and failure to thrive.

How is brain arteriovenous malformation diagnosed?

A diagnosis by your doctor for a brain arteriovenous malformation, or AVM, will require a physical examination and study of your symptoms.

One or more tests can diagnose brain AVM. Imaging examinations are usually performed by neuroradiologists who are radiologists with training in imaging of the brain and nervous system.

Tests that help to detect brain AVMs are:

• Brain Angiogram: This is the most accurate test that is used for diagnosing a brain AVM. Cerebral angiography will reveal the location of the draining veins and the feeding arteries that are critical in treatment planning. Cerebral angiography is another name for cerebral arteriography.

This test requires a long, thin tube known as a catheter to be inserted into a wrist or groin artery. X-ray imaging is used to thread the catheter into the brain. To make the blood arteries in the brain visible during X-ray imaging, a dye is injected into them.

• CT scan (computerised tomography): A CT scan produces a finely detailed cross-sectional image of the brain by using a sequence of X-rays.

Sometimes a tube is placed in a vein, and dye may be injected before the CT scan. Such a study is referred to as computerized tomography angiography. The dye can help in viewing the emptying veins from the AVM and the supplying arteries in better detail.

• MRI: MRI is an acronym for magnetic resonance imaging. It generates highly detailed images of the brain using radio waves and powerful magnets.

MRI can detect tiny changes in brain tissue associated with a brain AVM and is more sensitive than CT.

The precise location of the brain AVM and any associated brain haemorrhage are also shown by MRI. The data is crucial for therapy planning.

Another option is to inject a dye to observe how blood flows through the brain. Magnetic resonance angiography is the name given to this kind of test.

How is brain arteriovenous malformation treated?

Brain arteriovenous malformation (AVM) can be treated in a variety of ways. The main goal of treatment is to prevent bleeding, or haemorrhage. Seizures and other brain symptoms can also be controlled with treatment.

Your age, health, and the size and location of the brain AVM all influence the best course of treatment.

Headaches and seizures caused by the AVM may be treated with medication.

The most common treatment for brain AVMs is surgery. Three surgical options exist:

• Surgical excision, or resection: If the brain AVM has bled or is in a location that is easily accessible, surgery may be recommended. To reach the AVM, the surgeon must remove a part of the skull during this treatment.

The surgeon gently pulls the AVM off the surrounding brain tissue after having sealed it with special clips under a powerful microscope. The surgeon then seals the scalp incision and reattaches the skull bone.

Re-section is usually done if the AVM can be removed with minimal risk of bleeding or seizure. Deep brain AVMs are more likely to cause problems, so alternative therapies can be suggested.

• Embolisation of the blood vessels: In this surgery, a catheter is placed into a leg or wrist artery. X-ray imaging is used to guide the catheter through blood arteries to the brain.

One of the arteries that supply the brain AVM is where the catheter is placed. The surgeon injects an embolising agent. These can be small particles, a glue-like substance, microcoils, or other agents. By blocking the artery, the embolising agent reduces blood flow to the AVM.

The advantage of endovascular embolisation is that it is less invasive compared to conventional surgery. It can be performed alone but is often used to make other surgical procedures safer. It achieves this by lowering the risk of bleeding or reducing the size of the brain AVM.

By restoring blood to brain tissue, endovascular embolisation can be used to reduce stroke-like symptoms in some large brain AVMs.

• SRS is short for stereotactic radiosurgery: This type of treatment using radiation precisely focuses on the destruction of the AVM. In contrast to other procedures, no incisions in the body are made.

Instead, SRS targets the AVM with several highly focused radiation beams to cause damage to the blood vessels and scar them. After one to three years, the scarred AVM blood channels gradually close.

Small AVMs that are not easily resected by conventional surgery might be treated through this method. AVMs that have not caused dangerous haemorrhages may also undergo this procedure.

In contrast to operating on a brain AVM, physicians may recommend you be observed instead. If your symptoms are very mild or non-existent, or if the location of your AVM makes surgery difficult or potentially dangerous, your physician might suggest you be monitored instead. Regular visits with your care team are one part of monitoring.

Can brain arteriovenous malformation be prevented?

No, it cannot be prevented since researchers believed that AVMs are born with you (congenital). However, if you show any of these symptoms mentioned on this article, visit your physician at once. Taking action as soon as symptoms appear is the best approach.

When should I see my medical provider?

Arteriovenous malformations may recur in some people. See your provider if you have new symptoms. After you have received treatment, you will need to see your provider every three months. After one year, you will only need to see your provider once a year.

When should I go to the ER?

Seek emergency care if you have:

• Sudden, severe headache ("worst in my life").
• Seizures.
• Weakness in your arms or legs.
• Issues with your vision, balance, memory or attention.
• These are symptoms of a potentially life-threatening emergency. It might be a brain bleed.

Why Tender Palm Super-Speciality Hospital for brain arteriovenous malformation?

Tender Palm Hospital, owned by doctors, is renowned for attracting the most experienced professional in the country. With the finest neurologist and neurosurgeons specialized in brain arteriovenous malformation. Tender Palm stands out as the premier Neurology hospital in Lucknow, India. Boasting cutting-edge infrastructure and advanced technology, Tender Palm ensures top-notch medical care for its patients.

To seek an expert consultation for any Neurology condition

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