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AVM Presentation

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Brain Arteriovenous Malformations

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Abstract

Cerebral AVMs may go entirely unnoticed, or they may present with neurological symptoms, such as headache, focal neurological deficits, epileptic seizures or intracerebral hemorrhage with decreased levels of consciousness or death. The objective of the subsequent chapter is to outline the various mechanisms of clinical AVM presentation, and their frequency in a given patient population. Due to widespread availability of advanced cranial imaging such as MRI, more and more cerebral AVMs are found incidentally in the western and in many Asian and Australian countries. The frequency of hemorraghic presentation is still in the range of 50% in large reported clinical series, however. Hemorrhage can have dramatic consequences, with up to 30% of mortality and 10–20% of permanent neurological deficits. Some factors, such as diffuse AVM nidus, AVM-associated aneurysms, deep venous drainage and posterior fossa localization predispose to AVM rupture. Epilepsy as a presenting mode of AVMs is reported to be in the range of 10–40%. It is important to distinguish the occasional or sporadic AVM-related seizure from repeated, or chronic seizure activity and from chronic, pharmacoresistent epilepsy due to cerebral AVM. The latter group of patients necessitates elaborate epilepsy surgical evaluation and should surgery be indicated for the AVM and for the epilepsy, the resection may go far beyond the limits of the AVM itself, in order to achieve good epileptological outcomes. Focal neurological deficits are the least likely way cerebral AVMs present, with no more than approximately 10% of patients reported in the respective literature. The so-called “steal-phenomenon” seems not to be responsible for focal neurological deficits in these patients, as has been proved by recent experimental and intraoperative studies. As in symptomatic epilepsy, it seems more likely that local mass-effect and repeated micro-hemorrhage with subsequent tissue scarring may be responsible for the development of focal neurological deficits. Deep localization, i.e. in the brain-stem or in the basal ganglia may also cause presentation with focal neurological deficits.

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Authors and Affiliations

  1. Department of Neurosurgery, Geneva University Medical Center & Medical Faculty, University of Geneva, Geneva, Switzerland

    Karl Schaller

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  1. Karl Schaller
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Correspondence to Karl Schaller .

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Editors and Affiliations

  1. Department of Neurosurgery and Neuro-oncology, Institute of Clinical Neurosciences, Military University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic

    Vladimír Beneš

  2. Department of Neurosurgery and Neuro-oncology, Institute of Clinical Neurosciences, Military University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic

    Ondřej Bradáč

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Schaller, K. (2017). AVM Presentation. In: Beneš, V., Bradáč, O. (eds) Brain Arteriovenous Malformations. Springer, Cham. https://doi.org/10.1007/978-3-319-63964-2_6

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  • DOI: https://doi.org/10.1007/978-3-319-63964-2_6

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