Last reviewed:September 2019
Last updated:May  2019

Summary

Definition

History and exam

Key diagnostic factors

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

Other diagnostic factors

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

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)
  • seizures (risk of hemorrhage)
  • pregnancy (risk of hemorrhage)
  • hypertension (risk of hemorrhage)

Diagnostic investigations

Investigations 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)
Full details

Treatment algorithm

Contributors

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.

Senior Resident

Department of Medicine (Neurology)

National University Health System

Singapore 

Disclosures

BT declares that he has no competing interests.

Senior Resident

Department of Neurosurgery

National University Health System

Singapore 

Disclosures

AL declares that he has no competing interests.

Consultant

Department of Radiology

St Bartholomew's and The Royal London Hospital

London 

UK

Disclosures

PB declares that he has no competing interests.

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.

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.

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. 

Peer reviewersVIEW ALL

Chairman

Professor of Neurosurgery

Department of Neurosurgery

Technical University of Munich

Munich

Germany

Disclosures

BM declares that he has no competing interests.

Assistant Professor of Neurology

Neurosurgery and Radiology

Rush University Medical Center

Chicago

IL

Disclosures

MC declares that he has no competing interests.

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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