A brain arteriovenous malformation is a tangle of abnormal vessels where arteries connect directly to veins without capillaries in between. It is usually present from birth and is often found in young adults after a bleed or a seizure.
Key symptoms
- Sudden severe headache, vomiting or loss of consciousness from a bleed
- Seizures
- Recurrent headaches
- Progressive weakness, numbness, or vision or speech problems
- Often no symptoms; found on imaging
What you find on exam
- Level of consciousness with the Glasgow Coma Scale
- Focal neurologic deficits
- Signs of raised intracranial pressure: papilledema, slow heart rate, high blood pressure
- Sometimes a bruit over the skull or eye
Tests
- Noncontrast CT head for acute bleeding
- MRI and MR or CT angiography to show the malformation
- Catheter angiography (digital subtraction) as the gold standard to plan treatment
- Coagulation tests and blood count before procedures
Treatment basics
- Acute bleed: airway, blood pressure control, neurosurgical care in an ICU
- Antiseizure medicine such as levetiracetam for seizures
- Surgical removal, stereotactic radiosurgery or embolization, chosen by size and location
- Observation for some unruptured lesions, with shared decision making
Red flags
- Sudden worst headache of life
- Falling Glasgow Coma Scale score or new weakness
- A first seizure in a young adult
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.