Arteriovenous malformations?

What is Arteriovenous Malformation?


Arteriovenous malformations (AVMs) are defects of the circulatory system that are generally believed to arise during embryonic or fetal development or soon after birth. Although AVMs can develop in many different sites, those located in the brain or spinal cord can have especially widespread effects on the body. Most people with neurological AVMs experience few, if any, significant symptoms. 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 generalized symptoms. AVMs also can cause a wide range of more specific neurological symptoms that vary from person to person, depending primarily upon the location of the AVM. Such 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.


Is there any treatment?


Medication can often alleviate general symptoms such as headache, back pain, and seizures caused by AVMs and other vascular lesions. However, the definitive treatment for AVMs is either surgery or focused irradiation therapy. The decision to perform surgery on any individual with an AVM requires a careful consideration of possible benefits versus risks. Because so many variables are involved in treating AVMs, doctors must assess the danger posed to individual patients largely on a case-by-case basis.


What is the prognosis?


The greatest potential danger posed by AVMs is hemorrhage. Researchers believe that each year between 2 and 4 percent of all AVMs hemorrhage. 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. Whenever an AVM is detected, the individual should be carefully and consistently monitored for any signs of instability that may indicate an increased risk of hemorrhage.


What research is being done?


The National Institute of Neurological Disorders and Stroke (NINDS) conducts research related to AVMs in its laboratories at the National Institutes of Health (NIH) and also supports additional AVM research through grants to major medical institutions across the country. A group of NINDS-sponsored researchers is currently studying large populations of patients with AVMs to formulate criteria that will allow doctors to predict more accurately the risk of hemorrhage in individual patients. Other scientists are seeking to refine the techniques now available to treat AVMs. Several ongoing studies are devoted to developing new noninvasive neuroimaging technologies to increase the effectiveness and safety of AVM surgery.