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| ==Background==
| | #REDIRECT[[Arteriovenous malformation (CNS)]] |
| *Focal abnormal conglomerations of dilated arteries and veins in the brain parenchyma
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| **Arterial blood flows directly into draining veins without capillary beds creating high pressure channels
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| **May rupture, causing intracerebral hemorrhage +/- intraventricular hemorrhage. Mechanism of rupture incompletely understood.
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| *Prevalence 0.14%
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| *Congenital lesions
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| **Majority are sporadic, not familial
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| **Associated with Osler- Weber-Rendu disease and Sturge-Weber syndrome
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| *Lifelong risk of bleeding
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| **2-4% per year, cumulative
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| ==Clinical Features==
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| *Hemorrhage (most common)
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| **42-72% of clinically apparent AVMs
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| **Usually by age 20-49
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| *[[Seizures]]
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| *Ischemia (by vascular steal – rare)
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| *[[Headaches]]
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| ==Differential Diagnosis==
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| *Venous angioma
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| *Cavernous malformation
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| *Capillary telangiectasia
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| ==Workup==
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| *CT/CTA
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| **CT delineates acute hemorrhage, CTA to show abnormal vasculature
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| *MRI/MRA
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| **Vessels appear as abnormal flow voids
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| **Both better than CT for visualizing structures in relation to AVM
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| *Angiography
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| **Gold standard to evaluate the architecture including arterial feeding, venous drainage, and AVM-associated aneurysms
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| ==Management==
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| *Surgical Resection
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| **Traditionally treatment of choice
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| *Radiosurgery (Gamma Knife or CyberKnife)
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| *Embolization (usually an adjunct treatment)
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| *Combination of above three in some cases
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| **Decision is based on AVM size, location, and patient factors
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| ==Disposition==
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| *In cases of acute hemorrhage or neurological decline, obvious need for immediate neurosurgical consultation
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| *If patient presents with headache or seizure and lesion is then found, may simply warrant outpatient neurosurgical evaluation
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| ==See Also==
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| ==External Links==
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| ==Sources==
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| *Friedlander, Robert. Arteriovenous Malformations of the Brain. The New England Journal of Medicine. June 2007; 356: 2704-12.
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| *Greenberg, Mark. Handbook of Neurosurgery. New York: Thieme, 2006. 835-838.
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| [[Category:Neuro]]
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