Cerebral arteriovenous malformation - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Cerebral arteriovenous malformation are congenital vascular lesions that enlarge with age.
Most commonly present with hemorrhage.
Diagnosis is made by brain computed tomography or magnetic resonance imaging and angiography.
Risk of arteriovenous malformation (AVM) rupture is reduced only by complete exclusion of the AVM from the intracranial circulation. Definitive treatment options include surgical excision and stereotactic radiosurgery. Endovascular embolization may be used as an adjunct, but new techniques are emerging.
Management decisions are made in the light of the lifetime risk of hemorrhage versus the risk of treatment.

Cerebral angiogram (left carotid artery injection, lateral view) showing posterior frontal arteriovenous malformation fed by pericallosal artery (thin arrow) with arterialized draining vein (thick arrow) draining to superior sagittal sinus

From the collection of Mr R. J. Edwards; used with permission

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Consolidation of the Spetzler-Martin grading system into the Spetzler-Ponce grading system
Left posterior frontal intracerebral hematoma secondary to ruptured arteriovenous malformation (axial unenhanced computed tomography scan)
Unruptured left parieto-occipital arteriovenous malformation (sagittal T1-weighted magnetic resonance imaging scan)
Unruptured left parieto-occipital arteriovenous malformation (axial T2-weighted magnetic resonance imaging scan)
Cerebral angiogram (left carotid artery injection, lateral view) showing posterior frontal arteriovenous malformation fed by pericallosal artery (thin arrow) with arterialized draining vein (thick arrow) draining to superior sagittal sinus

Citations

Key Articles

Al-Shahi R, Warlow C. A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. Brain. 2001 Oct;124(Pt 10):1900-26.[Abstract][Full Text]
Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986 Oct;65(4):476-83.[Abstract]
Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022 Jul;53(7):e282-361.[Abstract][Full Text]
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. 2017 Aug;48(8):e200-24.[Abstract]
Zuurbier SM, Al-Shahi Salman R. Interventions for treating brain arteriovenous malformations in adults. Cochrane Database Syst Rev. 2019 Sep 10;9(9):CD003436.[Abstract][Full Text]

Referenced Articles

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