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Cerebrovascular accident, also known as stroke, cerebral infarction, brain attack, is any
functional or structural abnormality of the brain caused by pathological condition of the
cerebral vessels of the entire cerebrovascular system. It is the sudden impairment of
cerebral circulation in one or more of the blood vessels supplying the brain. This pathology
either causes hemorrhage from a tear in the vessel wall or impairs the cerebral circulation
by a partial or complete occlusion of the vessel lumen with transient or permanent effects.
The sooner the circulation returns to normal after a stroke, the better the chances are for
complete recovery. However, about half of those who survived a stroke remain disabled
permanently and experience the recurrence within weeks, months, or years.
Thrombosis, embolism, and hemorrhage are the primary causes for CVA, with thrombosis
being the main cause of both CVAs and transient ischemic attacks (TIAs). The most
common vessels involved are the carotid arteries and those of the vertebrobasilar system at
the base of the brain.
A thrombotic CVA causes a slow evolution of symptoms, usually over several hours, and is
completed when the condition stabilizes. An embolic CVA occurs when a clot is carried
into cerebral circulation and causes a localized cerebral infarct. Hemorrhagic CVA is
caused by other conditions such as a ruptured aneurysm, hypertension, arteriovenous (AV)
malformations, or other bleeding disorders
Cerebral arteriovenous malformation
Causes
The cause of cerebral arteriovenous malformation (AVM) is unknown. The
condition occurs when arteries in the brain connect directly to nearby veins
without having the normal vessels (capillaries) between them.
Cerebral AVMs are rare. Although the condition is present at birth, symptoms
may occur at any age. Hemorrhages occur most often in people ages 15 to
20. It can also occur later in life. Some people with an AVM also have brain
aneurysms.
Symptoms
In about half of people with AVMs, the first symptoms are those of
a stroke caused by bleeding in the brain.
Symptoms of an AVM that is bleeding are:
Confusion
Seizures
Vision problems
Dizziness
Brain angiogram
Computed tomography (CT) angiogram
Head MRI
Electroencephalogram (EEG)
Head CT scan
Magnetic resonance angiography (MRA)
Magnetic resonance veinogram
Treatment
Finding the best treatment for an AVM that is found on an imaging test but is
not causing any symptoms can be difficult. Your doctor will discuss with you:
The risk that your AVM will break open (rupture). If this happens, there may
be permanent brain damage.
The risk of any brain damage if you have one of the surgical treatments listed
below.
Your doctor may discuss different factors that may increase your risk of
bleeding, including:
Your age
Your symptoms
Three surgical treatments are available. Some treatments are used together.
A catheter is guided through a small cut in your groin to an artery and then to
the small blood vessels in your brain where the aneurysm is located.
A glue-like substance is injected into the abnormal vessels to stop blood flow
in the AVM and reduce the risk of bleeding. This may be the first choice for some
kinds of AVMs, or if surgery cannot be done.
Stereotactic radiosurgery:
Radiation is aimed directly on the area of the AVM. This causes scarring and
shrinkage of the AVM and reduces the risk of bleeding.
It is particularly useful for small AVMs deep in the brain that are difficult to
remove by surgery.
AVMs that do not cause symptoms by the time people reach their late 40s or
early 50s are more likely to remain stable and rarely cause symptoms.
Possible Complications
Complications may include:
Brain damage
Intracerebral hemorrhage
Language difficulties
Seizures
Subarachnoid hemorrhage
Vision changes
Brain swelling
Hemorrhage
Seizure
Stroke