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Cerebral arteriovenous malformation

Last reviewed: 5 Aug 2025
Last updated: 17 Mar 2023

Summary

Definition

History and exam

Key diagnostic factors

  • sudden-onset focal neurologic deficit
  • seizures
  • reduced conscious level
Full details

Other diagnostic factors

  • sudden-onset headache
  • nausea
  • vomiting
  • confusion
  • gradual-onset headaches
  • hypertension
  • coma
  • gradual-onset focal neurologic deficit
  • cognitive dysfunction
Full details

Risk factors

  • familial (malformation)
  • previous hemorrhages (risk of hemorrhage)
  • drug abuse (risk of hemorrhage)
  • abnormal venous drainage (risk of hemorrhage)
  • small AVMs (risk of hemorrhage)
  • posterior fossa and deep AVMs (risk of hemorrhage)
  • coexisting aneurysms (risk of hemorrhage)
  • pregnancy (risk of hemorrhage)
  • hypertension (risk of hemorrhage)
Full details

Diagnostic tests

1st tests to order

  • brain CT
  • brain MRI
Full details

Tests to consider

  • brain digital subtraction angiogram
  • brain CT angiogram
  • brain magnetic resonance angiogram
  • CBC
  • clotting screen and group
  • electrolyte panel
  • drug toxicology screen
  • functional imaging
  • superselective Wada
  • neuropsychology
  • perfusion studies
  • electroencephalogram
  • visual fields
Full details

Emerging tests

  • 4D CT angiography (CTA)/magnetic resonance angiography (MRA)

Treatment algorithm

INITIAL

associated hematoma if significant mass effect

ACUTE

not surgical candidate

surgical candidate

pregnant

Contributors

Authors

Mervyn Lim, MBBS, MRCS, MPH

Senior Resident

Department of Neurosurgery

National University Health System

Singapore

Declarações

ML declares that he has no competing interests.

Leonard Yeo, MBBS, MRCP, MMed, ASN

Senior Consultant

Department of Medicine (Neurology)

National University Health System

Assistant Professor

Yong Loo Lin School of Medicine

National University of SIngapore

Singapore

Declarações

LY declares that he has no competing interests.

Benjamin Tan, MBBS, MRCP, MMed

Associate Consultant

Department of Medicine (Neurology)

National University Health System

Singapore

Declarações

BT declares that he has no competing interests.

Adriel Leong, MBBS, MRCS

Senior Resident

Department of Neurosurgery

National University Health System

Singapore

Declarações

AL declares that he has no competing interests.

Audrey Tan, BSc Medical Sciences (Hons), MBChB, MRCS

Senior Resident

Department of Neurosurgery

National University Health System

Singapore

Declarações

AT declares that he has no competing interests.

Pervinder Bhogal, MBBS

Consultant

Department of Radiology

St Bartholomew's and The Royal London Hospital

London

UK

Declarações

PB declares that he has no competing interests.

Yang Cunli, MBBS, FRCR, MMed, FAMS

Senior Consultant

Department of Diagnostic Imaging

National University Health System

Assistant Professor

Yong Loo Lin School of Medicine

National University of Singapore

Singapore

Declarações

YC declares that he has no competing interests.

Anil Gopinathan, MBBS, MD, DNB, FRCR, FAMS

Head of Division of Interventional Radiology

Senior Consultant

Department of Diagnostic Imaging

National University Health System

Assistant Professor

Yong Loo Lin School of Medicine

National University of Singapore

Singapore

Declarações

AG declares that he has no competing interests.

Agradecimentos

Dr Leonard Yeo, Dr Benjamin Tan, Dr Adriel Leong, Dr Audrey Tan, Dr Mervyn Lim, Dr Pervinder Bhogal, Dr Yang Cunli, and Dr Anil Gopinathan would like to gratefully acknowledge Dr Charles Matouk, Dr Catherine E. Gilkes, and Dr Richard J. Edwards, previous contributors to this topic, and the additional contribution of Dr Branden Cord and Dr Ryan Hebert.

Declarações

CM, CEG, and RJE declare that they have no competing interests.

Revisores

Bernhard Meyer, MD

Chairman

Professor of Neurosurgery

Department of Neurosurgery

Technical University of Munich

Munich

Germany

Declarações

BM declares that he has no competing interests.

Michael Chen, MD

Assistant Professor of Neurology

Neurosurgery and Radiology

Rush University Medical Center

Chicago

IL

Declarações

MC declares that he has no competing interests.

Jae H. Choi, MD

Research Director

Stroke Center/The Neurological Institute

Columbia-Presbyterian Medical Center

New York

NY

Declarações

JHC declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Al-Shahi R, Warlow C. A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. Brain. 2001 Oct;124(Pt 10):1900-26.Texto completo  Resumo

Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986 Oct;65(4):476-83. Resumo

Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022 Jul;53(7):e282-361.Texto completo  Resumo

Derdeyn CP, Zipfel GJ, Albuquerque FC, et al. Management of brain arteriovenous malformations: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017 Aug;48(8):e200-24. Resumo

Zuurbier SM, Al-Shahi Salman R. Interventions for treating brain arteriovenous malformations in adults. Cochrane Database Syst Rev. 2019 Sep 10;9(9):CD003436.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Cerebral arteriovenous malformation images
  • Diagnósticos diferenciais

    • Cerebral aneurysm
    • Cavernous hemangioma
    • Dural arteriovenous fistula
    Mais Diagnósticos diferenciais
  • Diretrizes

    • Guidelines for the management of spontaneous intracerebral hemorrhage
    • Clinical practice guidelines for management of brain arteriovenous malformations in eloquent areas
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Stroke: treatment

    Mais Folhetos informativos para os pacientes
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