Arteriovenous Malformations: Difference between revisions
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= Definition = | |||
* Fistulous connections b/w cerebral arteries & veins w/o a nml capillary bed. | |||
= Clinical Presentation = | |||
* Up to 40% present w/ unrelated Sx. | |||
* The remainder w/ Sx related to the AVM (focal deficit, H/A, sz) | |||
** These Sx may be assoc. w/ hemorrhage, mechanical compression, irritation | |||
* Medical attention in <span style="background-color:#fff2cc;">50% due to ruptured AVM</span> w/ hemorrhage (intraparenchymal MC, IVH, SDH, or SAH) | |||
Subgroups of Presentation - Ruptured, Unruptured ( ± w/ microhemorrhages) | |||
== Hemorrhagic Presentation == | |||
* Risk factors: Small size, deep location, exclusive deep venous drainage, and association with aneurysms. | |||
* Pts who initially presents w/ hemorrhage, have a high risk of <span style="background-color:#fff2cc;">rehemorrhage (20%–40%)</span>. | |||
** The <span style="background-color:#fff2cc;">highest risk is w/i the first yr</span>. | |||
== Seizures as a Presentation == | |||
* <span style="background-color:#fff2cc;">15%–35%</span> of initial presentation. | |||
* Common in supratentorial AVMs. | |||
* Related to hemorrhage, mass effect, or flow characteristics. | |||
* Risk factors: Superficial location, large nidus, cortical location. | |||
== Other Presentations == | |||
* <span style="background-color:#fff2cc;">Neurological deficits (<10%)</span>: Possibly due to steal <u>phenomenon</u>, microhemorrhages, mass effect. | |||
* Headaches: May be due to meningeal artery involvement or venous outflow obstruction. | |||
= Management = | |||
{{NoteBox|secondary}}<strong>Key articles</strong> | |||
{| style="border-collapse: collapse; width: 100%;" | |||
|- | |||
| style="width: 15%; vertical-align: top;" | [[ARUBA trial]] | |||
| style="width: 85%; vertical-align: top;" | Medical management alone is superior to interventional therapy for preventing death or stroke in unruptured brain AVM. (Lancet 2014) | |||
|}{{NoteBoxEnd}} | |||
= Old presentation = | = Old presentation = | ||
<center><html><iframe src="https://docs.google.com/presentation/d/e/2PACX-1vQXZicYB8oq5GaOTkLHpmWx4R7aEZAqsW163H32aAB0Lz3mtSqaq3rPy6LJOrNMrons1YEFdLC3z3xG/embed?start=false&loop=false&delayms=3000" frameborder="0" width="800" height=" | <center><html><iframe src="https://docs.google.com/presentation/d/e/2PACX-1vQXZicYB8oq5GaOTkLHpmWx4R7aEZAqsW163H32aAB0Lz3mtSqaq3rPy6LJOrNMrons1YEFdLC3z3xG/embed?start=false&loop=false&delayms=3000" frameborder="0" width="800" height="500" allowfullscreen="true" mozallowfullscreen="true" webkitallowfullscreen="true"></iframe></html></center> | ||
[[Category:Vascular Pathology]] | |||
[[Category:Cerebral Vascular Malformations]] | |||
Latest revision as of 01:53, 20 July 2024
Definition
- Fistulous connections b/w cerebral arteries & veins w/o a nml capillary bed.
Clinical Presentation
- Up to 40% present w/ unrelated Sx.
- The remainder w/ Sx related to the AVM (focal deficit, H/A, sz)
- These Sx may be assoc. w/ hemorrhage, mechanical compression, irritation
- Medical attention in 50% due to ruptured AVM w/ hemorrhage (intraparenchymal MC, IVH, SDH, or SAH)
Subgroups of Presentation - Ruptured, Unruptured ( ± w/ microhemorrhages)
Hemorrhagic Presentation
- Risk factors: Small size, deep location, exclusive deep venous drainage, and association with aneurysms.
- Pts who initially presents w/ hemorrhage, have a high risk of rehemorrhage (20%–40%).
- The highest risk is w/i the first yr.
Seizures as a Presentation
- 15%–35% of initial presentation.
- Common in supratentorial AVMs.
- Related to hemorrhage, mass effect, or flow characteristics.
- Risk factors: Superficial location, large nidus, cortical location.
Other Presentations
- Neurological deficits (<10%): Possibly due to steal phenomenon, microhemorrhages, mass effect.
- Headaches: May be due to meningeal artery involvement or venous outflow obstruction.
Management
Key articles
| ARUBA trial | Medical management alone is superior to interventional therapy for preventing death or stroke in unruptured brain AVM. (Lancet 2014) |