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Arteriovenous Malformation
WHAT YOU SHOULD
KNOW
An arteriovenous (r-TEER-e-o-VEE-nus) malformation (AVM)
is a cluster of arteries and veins connected directly together
without an intervening network of capillaries. In an AVM,
high-pressure blood from the arteries is pumped right into the
veins, causing them to balloon. Over time, the malformation
becomes very tangled and large, and can start to bleed
heavily.
Although the problem is sometimes found in the digestive
tract, it's much more serious when it occurs in the
brain.
Causes
Cerebral AVMs are a congenital problem, inherited at
birth.
Signs/Symptoms
Any one of the symptoms caused by a cerebral AVM could
just as easily result from an entirely different problem, so
the doctor must look at them all together in order to reach a
diagnosis. Among the typical signs are fainting, dizziness,
muscle weakness, tingling skin, throbbing headache, stiff neck,
difficulty talking or understanding, visual problems,
sensitivity to light, nausea, vomiting, and seizures. As the
problem grows worse, you may develop confusion or problems with
memory, thinking, and other mental
functions.
Care
Treatment depends on the size and location of the AVM
inside your head. Here are some of the
options.
-
Embolization: (EM-bull-i-ZAY-shun): In this
procedure, a thick medicine is put in the arteries leading
to the AVM to plug them up and prevent blood from reaching
it. Robbed of blood, the AVM dies. In some cases, only an
embolization is performed. In others, the doctor removes
the mass surgically after it has died.
-
Craniotomy: This operation requires opening a
section of the skull to reach the AVM. Using microscopic
surgery, the doctor then ties off the arteries that feed
the malformation and removes it.
-
Laser Surgery: After performing a craniotomy to
reach the malformation, the surgeon destroys it with a
laser.
-
Radiation Therapy : This procedure uses x-rays,
rather than surgery, to kill the AVM. To destroy it
completely, however, radiation may have to be repeated many
times over several years.
-
Medication: In some cases, other forms of treatment
may not be needed or may be too dangerous. Instead, your
doctor may give you water pills or medicines to prevent
seizures. You also may need to limit your activities to
keep the pressure inside your head from becoming too high,
to help prevent seizures, and to keep the AVM from
bleeding.
Risks
If you have symptoms, you need immediate treatment.
Without it, the AVM will probably begin to bleed, building up
pressure on the brain and ultimately killing
you.
IF YOU'RE HEADING FOR THE
HOSPITAL...
What to Expect While You're
There
Your experience in the hospital will depend on the type
of treatment the AVM requires. Whichever treatment is
scheduled, you're likely to first encounter a battery of tests
such as the following.
-
Angiogram: This test tells doctors which blood
vessels lead to the AVM. To make them show up better in an
x-ray, dye will be fed into your circulation through an IV
tube in an artery in your arm, neck, or groin. When the dye
enters your body, the area around the IV may burn and you
may develop a warm feeling, nausea, or a
headache.
-
CT Scan: This test, also called a "CAT" scan, uses a
special x-ray machine to take pictures of your brain. Like
an angiogram, the test employs a dye, in this case
introduced through an IV tube in a vein. People who are
allergic to shellfish sometimes react to this dye. If you
have such an allergy, make sure the doctor is aware of
it.
-
MRI: During an MRI (also called magnetic resonance
imaging), 3-D pictures of internal body structures are
created using a very large magnet and radio waves. The test
is noisy, but painless. Like the other tests, special dye
may be required.
-
Transcranial Color-Coded Sonography: This painless
test (also called ultrasound) uses sound waves to form
pictures of the interior of the brain. During the test,
your doctor will gently move a small handle through some
lotion on your head. A TV-like screen attached to the
handle will display pictures of blood flow in the
brain.
For specific procedures to expect before and after a
surgical repair, see "Arteriovenous Malformation,
Craniotomy."
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