Cerebral Arteriovenous malformations
The literal meaning of the term “arterio” and “venous” is related to arteries and veins respectively, and malformation is related to abnormality in their functions. Arteriovenous malformation is abbreviated as AVM, is a condition in which abnormal and poorly formed blood vessels (both arteries and veins) tangle together. A brain arteriovenous malformation is an abnormal connection between the arteries, veins and the brain.
AVMs have a higher rate of bleeding than normal blood vessels, and the cause is not known. AVMs can occur anywhere in the body, if it happens in the brain is of more concern because bleeding causes a lot of damage. The chance of occurrence is rare, less than 1% of the population can have the condition. The AVMs which occur in the covering of the brain are called DURAL AVMs. The cause of AVM is not known, can be present at birth known as “utero”, or may develop later due to an injury. AVM is not a cancer; it does not spread to other parts of the body.
Typical symptoms of AVM are headaches and seizures, though there is statistics of at least 15% of the population having no symptom at all. Some of the symptoms could be pulsing noise in the head, progressive weakness, numbness, vision changes as well as excruciating pain. Hemorrhage is the first symptom for most cases of AVM, while in serious cases blood vessels rupture and there is bleeding inside the brain. This is known as intracranial hemorrhage.
Some of the symptoms because of bleeding are loss of consciousness, sudden and severe headache, nausea, vomiting, blurred vision etc. Some impairment at the site of the bleeding can be seizure, one-sided weakness, loss of sense of touch on one side of the body, and difficulty in speech. After blood cessation in the AVM and blood vessel repairs itself most patients return to normal. AVM in certain critical locations can stop the circulation of the cerebrospinal fluid, which causes its accumulation in the skull which is a condition called hydrocephalus.
If AVM is suspected, it is established through neuroimaging after complete physical and neurological examination. The main techniques used to visualize the brain and search AVM are; Computed Tomography (CT) in Pune, Magnetic Resonance Imaging (MRI), and Cerebral Angiography. CT scan is a technique to detect bleeding in the brain or fluid spaces around the brain. The scan if performed with the dye enables to see arteriovenous malformation in the brain.
MRI is a more sensitive way than CT scan, and gives more accurate results of the malformations in the brain. If radioactive agents are injected in the blood stream, complementing either of the techniques detailed pictures of the tangle of blood vessels are obtained. If CT scan is used with dye, it is called Computerized Tomography Angiogram, whereas if MRI is used it is called Magnetic Resonance Angiogram.
The best procedure to detect AVM is Cerebral Angiography. In this procedure, a catheter is inserted in the artery in the groin. The thin tube is threaded to the blood vessel from the groin towards the head. A contrast agent, such as dye is injected in the blood vessels of the brain. As the dye flows, AVM is shown as a tangle of blood vessels, pictures of which are taken. This gives the most precise results related to the size and location of AVM. The course of treatment varies from patient to patient. Sometimes even a combination of treatment may be given. Some of the treatments are Embolization, Radiation treatment, or even surgery. Each course of treatment has some risk that is why it is given depending on the AVM and condition of the patient.
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