Brain Anteriovenous Malformation (AVM)

What is AVM.?

AVM stands for

anteriovenous
malformation. An
AVM is a tangle of
abnormal anf
poorly formed
blood vessels
(arteries and veins).
They have a higher
rate of bleeding
than normal
vessels. AVM can
occur anywhere in
the body. Brain
AVMs are of special
concern because of the damage they cause when they bleed. They are
very rare and occur in less than 1% of the general population. AVMs
that occur in the coverings of the brain are called dural AVMs.

What is the cause of AVM

The cause is not known. AVM are thought to be due to abnormal

development of blood vessels in utero and may be present since birth.
Most AVMs are not inherited with the exception of a condition called
H.H.T. An AVM is not a cancer, and does not spread to other parts of
the body. Dural AVMs in adults are an acquired disorder that can occur
following an injury.

Who gets an AVM

They can occur in people with any races and sexes in almost equal
proportions. The typical time of discovery is between the ages of 20
and 40 years.
Why is it important to treat AVM

Treatment is offered is to try to prevent bleeding from the AVM.

Bleeding may injure the surrounding brain resulting in a stroke =, with
possible permanent
disability or even
death. The risk of
bleeding is 4% per
year which means 4
out of every 100
people with an VM
will have a bleed( hemorrhage) during any one year. AVMs may also
produce headaches, seizures and progressive paralysis, and the
reatment may alleviate these symptoms.

What kind of symptoms do AVMs cause.?

Symtoms of an AVM:

A variety of symtoms may be produced which will depend on the

location and size of the AVM. Common problems including:

1. Seizures: and aAVM in te brain may act as an irritant resulting in

abnormal electil activity. Seizure may develop as a result of this
hyperactivity.
2. Headache: headaches may be caused by the highblood flow
through the AVM. These headaches may be similar to migraine or
be actual migraines. They are mild to quite disabling. Sudden,
severe headaches can be caused by bleeding. These headaches
are often followed by nausea, vomiting, neurological problems or
a decreasing level of consciousness
3. Stroke- like- symptoms: Brain AVMs may cause stroke like
symtoms by depriving the nerby brain tissue of oxygen and
nutrients. The symtoms vary with the location of the AVM and
include:
a. Weakness or paralysis on one side of the body
 b. Numbness and tingling
c. Problems with vision, hearing, balance, memory and
personality changes
4. Bleeding: this is the most serious complication of an AVM. It is the
most reason for recommending treatment. Bleeding from an AVM
will occur in about 1 out of 10 perople with a brain AVM every
year. Sometimes, a bleed may be small and produce no noticeable
symtoms. Approximately 50% of the bleeds are significant with
permanent disability in half of these cases and death in the other
half.

How are AVMs diagnosed.?

There are three main tests that are used to diagnose AVMs. These
are:

Cerebral Angiography (Angiogram): a thin tube is inserted into an

artery in the groin. This thin tube is threaded up into the blood
vessel from the groin toward the brain. Dye is injected into the blood
vessels of the brain and pictures are taken. An AVM will show up as a
tangle of blood vessels.

Magnetic resonance imaging (MRI): is a method of producing highly

detailed images of the body without the need for X-ray. MR
angiography (MRA) utilizes “pulse sequences” specifically designed to
show the arteries and veins of the brain as well as the AVM. MRI
examination show in detail the AVM and it relationship to the brain.

Computerized Tomography (CT scan): uses X-rays to image different

parts of the body. CT scanning is an excellent method of detecting
bleeding into the brain or the fluid spaces around the brain. The study
of the brain may be done with or without dye. On the CT scan it may be
possible to see an anteriovenous malformation of the brain, in
particular after X-ray dye is given.
Electrical Burns
Electrical burn severity is determined by the voltage, current
and type of current, duration of contact and resistance at
contact points. High voltage electrical injuries (>1000 volts)
meet the victorian State Trauma Systems Major Trauma
criteria.
Low voltage injuries are usually sustained in domestic (240
voltssingle phase
AC) or industrial
(415 volts 3 phase
AC) settings. In
general, low
voltage injuries are
associated with
localized areas of
tissue destruction.
High voltage
electrical injuries
occur as a result of
contact with overhead powerlines and other sources of high
voltage electrical currents. High Voltage Electrical injuries tend
to be characterized by deep, extensive tissue damage with 3
general pattern injury:

 True electrical injury caused by current flow

 Electrical arc injury caused by arc of current source to be
object
 Flame injury from ignition of clothes etc.
High Voltage injuries are commonly associated with other
traumatic injuries.
Medical Therapy
Patients with electrical injury should be initially evaluated as a
trauma patient. Airway, breathing, circulation, and inline
immorbilization of the spine should be performed as a part of
primary survey. Maintain a high index of suspicion and evaluate
for hidden injuries. Intravenous access, cardiac monitoring and
measurement of oxygen saturation should be started during
primary survey. Fluid replacement is the most important aspect
of the initial resuscitation. As with conventional thermal injury,
electrical injuries caused massive fluid shifts with extensive
tissue damage and acidosis, therefor monitoring patients
hemodynamics is important. A foley catheter is helpful in
monitoring urine output and therefore, tissue perfusion.
Initial fluid resuscitation should aim for urine output of greater
than 0.5 cc/kg/h if no signs of myoglobinuria are present and
preferably greater than 1 cc/kg/h if myoglobinuria is present.
Since lightning burns are superficial, using a stand formula such
as the Parkland formula, may be helpful
 Cebu Institute of Technology University
College of Nursing

Vicente Sotto Memorial Medical Center

Out Patient Department

Submtted by:
France Jannica G. Petallar
 Cebu Institute of Technology University
College of Nursing

Vicente Sotto Memorial Medical Center

Out Patient Department

Submtted by:
Gio R. Cabuntala