Cerebral arteriovenous malformation

Last reviewed: 17 Apr 2022
Last updated: 29 May 2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • sudden-onset focal neurological deficit
  • seizures
  • reduced conscious level
More key diagnostic factors

Other diagnostic factors

  • sudden-onset headache
  • nausea
  • vomiting
  • confusion
  • gradual-onset headaches
  • hypertension
  • coma
  • gradual-onset focal neurological deficit
  • cognitive dysfunction
Other diagnostic factors

Risk factors

  • familial (malformation)
  • previous haemorrhages (risk of haemorrhage)
  • drug abuse (risk of haemorrhage)
  • abnormal venous drainage (risk of haemorrhage)
  • small AVMs (risk of haemorrhage)
  • posterior fossa and deep AVMs (risk of haemorrhage)
  • co-existing aneurysms (risk of haemorrhage)
  • seizures (risk of haemorrhage)
  • pregnancy (risk of haemorrhage)
  • hypertension (risk of haemorrhage)
More risk factors

Diagnostic investigations

1st investigations to order

  • brain CT
  • brain MRI
More 1st investigations to order

Investigations to consider

  • brain digital subtraction angiogram
  • brain CT angiogram
  • brain magnetic resonance angiogram
  • FBC
  • clotting screen and group
  • electrolyte panel
  • drug toxicology screen
  • functional imaging
  • superselective Wada
  • neuropsychology
  • perfusion studies
  • electroencephalogram
  • visual fields
More investigations to consider

Emerging tests

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

Treatment algorithm

INITIAL

associated haematoma if significant mass effect

ACUTE

not surgical candidate

surgical candidate

Contributors

Authors

Leonard Yeo, MBBS, MRCP, MMed, ASN

Consultant

Department of Medicine (Neurology)

National University Health System

Assistant Professor

Yong Loo Lin School of Medicine

National University of SIngapore

Singapore

Disclosures

LY declares that he has no competing interests.

Benjamin Tan, MBBS, MRCP, MMed

Senior Resident

Department of Medicine (Neurology)

National University Health System

Singapore

Disclosures

BT declares that he has no competing interests.

Adriel Leong, MBBS, MRCS

Senior Resident

Department of Neurosurgery

National University Health System

Singapore

Disclosures

AL declares that he has no competing interests.

Paul Bhogal, MBBS

Consultant

Department of Radiology

St Bartholomew's and The Royal London Hospital

London

UK

Disclosures

PB declares that he has no competing interests.

Yang Cunli, MBBS, FRCR, MMed, FAMS

Consultant

Department of Diagnostic Imaging

National University Health System

Assistant Professor

Yong Loo Lin School of Medicine

National University of Singapore

Singapore

Disclosures

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

Disclosures

AG declares that he has no competing interests.

Acknowledgements

Dr Leonard Yeo, Dr Benjamin Tan, Dr Adriel Leong, Dr Paul 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.

Disclosures

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

Peer reviewers

Bernhard Meyer, MD

Chairman

Professor of Neurosurgery

Department of Neurosurgery

Technical University of Munich

Munich

Germany

Disclosures

BM declares that he has no competing interests.

Michael Chen, MD

Assistant Professor of Neurology

Neurosurgery and Radiology

Rush University Medical Center

Chicago

IL

Disclosures

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

Disclosures

JHC declares that he has no competing interests.

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