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Arteriovenous malformations
Facts | Symptoms | Causes | Treatment options
Facts
Arteriovenous
malformations (AVMs) are defects of the circulatory system that are generally
believed to be present at birth or to develop soon thereafter.
AVMs
can develop in many different parts of the body, but those located in
the brain or spinal cord can have particularly widespread effects.
The
greatest potential danger posed by AVMs is hemorrhage. It is estimated
that between 2 and 4 percent of all AVMs hemorrhage each year. Most episodes
of bleeding remain undetected at the time they occur because they are
not severe enough to cause significant neurological damage. But massive,
even fatal, bleeding episodes do occur. When an AVM is detected, the person
should be closely and periodically monitored for any signs that may indicate
an increased risk of hemorrhage.
 Symptoms
Most
people with neurological AVMs experience few significant symptoms, if
any. The malformations tend to be discovered only incidentally,
usually either at autopsy or during treatment for an unrelated disorder.
But for about 12 percent of the affected population (about 36,000 of
the estimated 300,000 Americans with AVMs), these abnormalities cause
symptoms that vary greatly in severity.
Seizures
and headaches are the most common symptoms. AVMs also can cause
a wide range of more specific neurological symptoms that vary from person
to person, depending mostly on the location of the AVM. These symptoms
may include muscle weakness or paralysis, loss of coordination, difficulties
carrying out tasks that require planning, dizziness, visual disturbances,
problems using or understanding language, abnormal sensations (such as
numbness, tingling, or spontaneous pain), memory deficits, mental confusion,
hallucinations or dementia.
Causes
AVMs
may result from arteries being connected directly to veins. During development
inside the womb, the arteries do not divide into capillaries before joining
veins. Without capillaries that reduce the pressure in blood vessels,
the higher pressure inside the arteries may cause rupture or bleeding
because the veins are not able to tolerate as much pressure as arteries.
Surrounding brain cells do not receive an adequate amount of oxygen, which
may result in the formation of scar tissue.
Treatment
Medication
can often alleviate general symptoms associated with AVMs and other vascular
lesions such as headache, back pain and seizures. However, definitive
treatments for AVMs include surgery, focused irradiation therapy or stereotactic
radiosurgery.
The
decision to perform surgery on an individual with an AVM requires a careful
consideration of possible benefits versus risks. Since so many variables
are involved in treating AVMs, doctors must assess the danger posed to
individual patients largely on a case-by-case basis.
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