By Thomas Kosztowski, MD of Texas Back Institute.
Although they are rare, each year in the US about 200,000 arteriovenous malformations (AVMs) are diagnosed.
These AVMs can be found anywhere in the body, but they are most common in the brain or spinal cord. Approximately 10 per cent of AVMs are fatal.
AVMs are abnormal formations of blood vessels in the brain, where the blood does not flow through normal tissue and instead flow directly from the arteries to the veins.
Blood pumps through the arteries at a high pressure, but the veins can only handle low pressure.
When the blood flows directly through the veins at a high pressure, it can cause damage to the vessels and eventually could burst, causing hemorrhaging.
While the cause of AVMs is unknown, they are believed to be congenital in most cases.
In rare cases, they can be formed later in life. It is even possible for some people to experience AVMs throughout their life and never know it.
Symptoms and treatment
Thomas Kosztowski, MD of Texas Back Institute.
Symptoms of an AVM could be anything neurologic, including headaches, seizures, trouble talking, weakness, numbness, loss of vision, confusion, or instability. Some AVMs are observed over time.
Treatment of this condition depends on the size, location, and how symptomatic it is.
If an AVM requires treatment, there are different modalities which can be used including stereotactic radiation, endovascular embolisation (glue) into the vessels, and /or microsurgery to remove it.
Embolisation is the most common way to treat an AVM.
If surgery is needed, it is done as a microsurgery, and the blood flow of the patient is redirected to normal blood vessels.
Meet Athenas Ramirez – AVM survivor
After donning a pair of virtual reality goggles, Athenas experienced a serious headache and then a blackout episode. While lying down after this, her father checked on her and noticed she was unconscious.
He realised there was something very wrong and acted quickly.
After waking in the ER, she was told that she was born with smaller than normal veins in her brain and that AVMs had “tangled up” these veins.
Unfortunately, this caused one of these veins to rupture, resulting in blood flowing into her brain and causing a stroke.
Emergency surgery was performed to stop the bleeding, and then the blood was suctioned from her brain.
A coma was induced to allow the swelling in her brain to recede.
A second surgery was later performed to correct this blood flow challenge.
With surgery and rehabilitation, Athenas recovered and is living a healthy life.
To see her personal story of this AVM experience, click here.
Recognising the symptoms
Emergency room and primary care physicians play a crucial role in recognising the symptoms of AVMs and the timely treatment of resulting episodes.
Because of its rarity, patients, their families, and even medical professionals are unaware of the potential for long-term damage to the brain. If symptoms are present, swift action is required.
Thomas Kosztowski, MD, is a neurosurgeon at the Texas Back Institute in Plano, Texas. He received his medical degree and did his Residency at Johns Hopkins Hospital. While at Johns Hopkins Hospital, he completed a minimally invasive and complex spine fellowship, followed by a postgraduate spine fellowship at Brown University Rhode Island Hospital.
