Arteriovenous Malformations: Difference between revisions
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{{NoteBox|secondary}}<strong>Key articles</strong> | {{NoteBox|secondary}}<strong>Key articles</strong> | ||
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* [[ARUBA trial]] - Medical management alone is superior to interventional therapy for preventing death or stroke in unruptured brain AVM. (Lancet 2014){{NoteBoxEnd}} | * [[ARUBA trial]] - Medical management alone is superior to interventional therapy for preventing death or stroke in unruptured brain AVM. (Lancet 2014){{NoteBoxEnd}} | ||
Revision as of 01:51, 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
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- ARUBA trial - Medical management alone is superior to interventional therapy for preventing death or stroke in unruptured brain AVM. (Lancet 2014)