Pathophysiology of Arteriovenous Anomaly-Related Hemorrhage

  • Jae H. Choi
  • John Pile-Spellman
Part of the Stroke Revisited book series (STROREV)


Although uncommon, brain arteriovenous malformations (AVM) and dural arteriovenous fistula (DAVF, also known as dural AVM) are two important causes for intracranial hemorrhage. Characteristic of these intracranial vascular malformations is the direct connections between artery and vein, so-called AV shunts, where capillaries are missing. Brain AVMs have a nidus, a complex tangled bundle of abnormal vessels, between feeding artery and draining vein. The angioarchitecture of brain AVMs may be complex with multiple feeding arteries, occupation of a large space within the cerebral or cerebellar hemisphere, flow-related and intranidal aneurysms, connection to ventricular system, and superficial and deep draining veins. DAVFs are located along the dura with one or multiple feeders mostly from the meningeal arteries and may drain directly into a venous sinus or via cortical and leptomeningeal veins. DAVFs do not form a nidus. Brain AVMs are considered congenital lesions, whereas trauma, thrombosis, and atherosclerosis are known mechanisms for DAVFs. However, most DAVFs are idiopathic. Clinical factors and anatomical and angioarchitectural features of these lesions have been identified that are related to intracranial hemorrhage. Intranidal and venous hypertension, inflammation, angiogenesis, and genetic factors are thought to be important mechanisms in the pathogenesis of these rare lesions.


Brain AVMs Leptomeningeal Veins Dural Arteriovenous Fistula Intracranial Vascular Malformations Multiple Feeding Arteries 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media Singapore 2018

Authors and Affiliations

  • Jae H. Choi
    • 1
    • 2
    • 3
  • John Pile-Spellman
    • 1
    • 3
  1. 1.Center for Unruptured Brain Aneurysms, Neurological Surgery, P.CLake SuccessUSA
  2. 2.Department of NeurologyState University of New York, Downstate Medical CenterBrooklynUSA
  3. 3.Hybernia Medical, LLCUniondaleUSA

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