How does malformation work?
In a healthy brain, blood from the arteries passes through a dense network of capillaries, where it releases oxygen, and only then enters the veins. With arteriovenous malformation, this intermediate stage is absent: arterial blood under high pressure is discharged directly into the veins. The veins dilate and become thinner, and the adjacent brain tissue does not receive enough blood and gradually suffers. The tangle of vessels itself is called the core of the malformation. Aneurysms often form inside it, which further increases the risk of rupture. Malformations are formed in utero and are not associated with lifestyle.
- Direct discharge of blood from arteries to veins
- Dilated thin-walled vessels
- Stealing from neighboring areas of the brain
- Often associated aneurysms
- Innate character, grows with the person
How it manifests itself
In about half of patients, the first manifestation is hemorrhage, which develops suddenly: a severe headache occurs, often with vomiting, impaired consciousness, weakness in the limbs or speech impairment. In others, the disease manifests itself with epileptic seizures, as altered blood vessels irritate the cerebral cortex. Often persistent headaches occur, sometimes on one side, as well as gradually increasing disturbances in speech, vision, and coordination, depending on the location of the malformation. Some malformations remain asymptomatic throughout life.
- Hemorrhage with sudden headache
- Epileptic seizures
- Persistent headaches
- Weakness or numbness in the limbs
- Speech and vision disorders
- Noise in the head that coincides with the pulse
Survey
If hemorrhage is suspected, the first step is to perform a CT scan of the head. For routine examination, magnetic resonance imaging with vascular assessment is better suited: it shows the malformation itself, its relationship to functionally important areas and traces of minor hemorrhages. CT angiography clarifies the structure of the feeding arteries. Cerebral angiography remains the gold standard before treatment, in which contrast is injected directly into the brain vessels and a detailed map is obtained. During attacks, an EEG is additionally prescribed.
- CT scan of the head for suspected hemorrhage
- MRI of the brain and blood vessels
- CT angiography of intracranial arteries
- Cerebral angiography before treatment
- EEG for seizures
- Blood pressure control
Treatment Options
There is no single solution for everyone: the doctor compares the risk of spontaneous hemorrhage with the risk of the intervention itself, taking into account the size, location, structure of the veins and the age of the patient. Microsurgical removal allows you to immediately turn off the malformation, but is not suitable for all locations. Endovascular embolization is carried out through the vessels and is often used as a preparatory step. Stereotactic radiosurgery uses targeted radiation, the effect develops over 1–3 years. Sometimes the most informed decision is observation with blood pressure monitoring and treatment of attacks.
- Microsurgical removal of malformation
- Endovascular embolization
- Stereotactic radiosurgery
- Combination of methods
- Dynamic observation at high risk of intervention
- Anticonvulsant therapy for seizures
- Strict blood pressure control
Living with a diagnosis
If observation is chosen, it is important to know the signs of hemorrhage and, if they appear, immediately call an ambulance by dialing 103. Controlling blood pressure is the most accessible risk reduction measure. You should avoid smoking and uncontrolled use of drugs that affect blood clotting, and discuss any new therapy with your doctor. For women with malformation, pregnancy is planned together with a neurosurgeon and obstetrician-gynecologist. Physical activity is usually not completely prohibited, but intense strength loads with straining are discussed separately.
- Know the signs of hemorrhage and act quickly
- Maintain normal blood pressure
- Stop smoking
- Do not take blood thinning medications unless prescribed
- Regular monitoring and follow-up imaging
- Planning pregnancy with specialists
- Taking anticonvulsants without interruption when prescribed