Brain AVMs: Symptoms, Risks, and Diagnosis Explained - Neurosurgery

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I have a slight numbness and pain in my head?


1.
Can a brain ultrasound performed during infancy detect arteriovenous malformations (AVMs)?
2.
If there is no family history of stroke or arteriovenous malformations, but there is a history of diabetes and hypertension, what is my approximate risk?
3.
What are the differences in daily manifestations between arteriovenous malformations and normal conditions?
4.
Is the bleeding from arteriovenous malformations usually substantial?
5.
How can one differentiate between headaches and dizziness caused by autonomic dysfunction and those caused by cerebral hemorrhage?
6.
What is the likelihood of experiencing severe bleeding due to arteriovenous malformations?
7.
What are the background factors associated with arteriovenous malformations?
8.
Are there any warning signs before bleeding occurs from arteriovenous malformations?

Wu Yan, 10~19 year old female. Ask Date: 2020/09/10

Dr. Lai Zhaokang reply Neurosurgery


Hello: 1.
If the malformation is superficial and large enough, a brain ultrasound may be able to detect it.
However, as the infant grows, it may not be visible at that time.
Over the years, the congenital arteriovenous malformation may also change and enlarge, potentially being discovered later.
2.
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8.
Your questions are very profound and extensive.
Due to the limitations of this webpage, I suggest you refer to the following publicly available links from Taiwan for further reading.
Best wishes: https://kb.commonhealth.com.tw/library/136.html http://www2.cmu.edu.tw/~cmcmd/ctanatomy/clinical/BrainAVM.html https://www.cgmh.org.tw/cgmn/category.asp?id_seq=1409006#.X1sQ0PYzbcs https://www.commonhealth.com.tw/article/article.action?nid=74452

Reply Date: 2020/09/10

More Info


Understanding brain arteriovenous malformations (AVMs) is crucial for recognizing their symptoms, risks, and diagnostic methods. Here’s a comprehensive overview addressing your questions.

1. Can brain AVMs be detected in an ultrasound during infancy?
Yes, brain AVMs can sometimes be detected using cranial ultrasound in infants. This imaging technique is particularly useful in the neonatal period because it is non-invasive and can provide real-time images of the brain. However, the sensitivity of ultrasound may not be as high as other imaging modalities like MRI or CT scans, which are more definitive for diagnosing AVMs.

2. What is the likelihood of developing an AVM if there is no family history of stroke or AVMs, but there is a history of diabetes and hypertension?
While having a family history of AVMs or strokes can increase the risk, the presence of diabetes and hypertension can also contribute to vascular health issues. However, the exact probability of developing an AVM is difficult to quantify without specific genetic factors or other risk indicators. Generally, AVMs are considered sporadic, and most individuals with diabetes and hypertension do not develop them.

3. How do the daily manifestations of AVMs differ from normal conditions?
Many individuals with AVMs may be asymptomatic, meaning they show no symptoms. However, when symptoms do occur, they can include headaches, seizures, neurological deficits, or signs of increased intracranial pressure. These symptoms can differ significantly from normal conditions, where headaches might be less severe and not associated with neurological signs.
4. Is the bleeding from an AVM typically large?
The volume of bleeding from an AVM can vary. Some AVMs may bleed profusely, leading to significant hemorrhagic strokes, while others may bleed in smaller amounts. The risk of bleeding is a critical concern, as it can lead to serious complications, including permanent neurological damage or death.

5. How can one differentiate between headaches and dizziness caused by autonomic dysfunction versus those caused by a brain hemorrhage?
Headaches from autonomic dysfunction often present as tension-type headaches or migraines, typically associated with stress, anxiety, or other triggers. In contrast, headaches due to a brain hemorrhage are often described as sudden, severe, and "thunderclap" in nature, sometimes accompanied by neck stiffness, nausea, vomiting, or altered consciousness. If there is any suspicion of a hemorrhage, immediate medical evaluation is crucial.

6. What is the risk of severe bleeding from an AVM?
The risk of severe bleeding from an AVM varies based on its size, location, and other individual factors. Studies suggest that the annual risk of hemorrhage can range from 2% to 4%. However, once an AVM has bled, the risk of subsequent bleeding increases significantly.

7. What are the background factors associated with AVMs?
The exact cause of AVMs is not fully understood, but they are believed to be congenital, meaning they develop during fetal development. Factors that may contribute include genetic predispositions, although most cases are sporadic. Other vascular conditions may also increase the risk.

8. Are there warning signs before an AVM bleeds?
In many cases, there are no clear warning signs before an AVM bleeds. However, some individuals may experience symptoms like headaches or neurological changes that could indicate increased pressure or irritation in the brain. These symptoms should prompt immediate medical evaluation.

In conclusion, brain AVMs are complex vascular malformations that can lead to significant health risks, including hemorrhage. Understanding the symptoms, risks, and diagnostic methods is essential for early detection and management. If there are concerns about AVMs or related symptoms, consulting a healthcare professional for appropriate imaging and evaluation is crucial. Regular monitoring and maintaining a healthy lifestyle can also help manage risk factors associated with vascular health.

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