BRAIN ARTERIOVENOUS MALFORMATIONS (AVMS)

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A brain arteriovenous malformation (AVM) is an abnormal tangle of blood vessels connecting arteries and veins in the brain. This tangle disrupts the normal flow of blood and can cause various health issues, including bleeding in the brain (hemorrhage).

Brain AVMs are relatively rare, affecting about 1 in 100,000 people. They can occur in any part of the brain and are typically present at birth, although symptoms might not appear until later in life.

The symptoms of a brain AVM can vary depending on its size and location. Some people may never experience symptoms, while others may have:

• Seizures
• Headaches, which can be severe
• Weakness or numbness in part of the body
• Difficulty speaking or understanding language
• Vision problems, such as loss of vision or double vision
• Unsteady gait or balance issues
• Cognitive or neurological changes

Diagnosing a brain AVM involves several steps:

• Medical History and Physical Exam: Your doctor will review your symptoms and perform a neurological examination.
• Imaging Tests: Various imaging techniques are used to detect AVMs:
  • MRI (Magnetic Resonance Imaging): Provides detailed images of the brain's structure and blood vessels.
  • CT Scan (Computed Tomography): Helps to detect bleeding in the brain.
  • Cerebral Angiography: A detailed imaging test where a contrast dye is injected into the arteries, allowing for clear visualization of the blood vessels.
  • CT Angiography (CTA) and MR Angiography (MRA): Specialized scans that give detailed images of blood vessels and can highlight the AVM.

Treatment for brain AVMs depends on their size, location, and whether they have caused symptoms or bleeding. Options include:

• Observation: Small AVMs that are not causing symptoms may be monitored with regular imaging tests.
• Medications: Drugs can help manage symptoms such as seizures and headaches but do not treat the AVM itself.
• Surgery: Surgical removal of the AVM may be recommended if it is accessible and the risk of bleeding is high.
• Endovascular Embolization: A minimally invasive procedure where a catheter is used to inject a glue-like substance into the AVM, blocking the abnormal blood flow.
• Stereotactic Radiosurgery: A non-invasive treatment that uses focused radiation beams to shrink and close off the AVM over time.

There are different surgical techniques for treating brain AVMs:

• Microsurgical Resection: This involves opening the skull and physically removing the AVM. It is often the preferred treatment for AVMs that are accessible and pose a high risk of bleeding.
• Endovascular Embolization: A catheter is navigated through the blood vessels to the AVM site, where an agent is injected to block the abnormal vessels. This procedure can be used alone or in combination with surgery or radiosurgery.
• Stereotactic Radiosurgery (Gamma Knife or CyberKnife): This technique delivers precise radiation to the AVM, causing the blood vessels to thicken and close off over time. It is usually used for smaller AVMs or those located in hard-to-reach areas.

Early detection and treatment of brain AVMs can prevent complications and improve outcomes. If you experience symptoms or have concerns about brain AVMs, it's important to consult your healthcare provider for a thorough evaluation.