Avm Stroke: Recovery, Possibilities, And Hope

Arteriovenous Malformations (AVMs) are a rare tangle of blood vessels, usually in the brain, which can cause strokes if left untreated. AVMs occur when arteries and veins form direct connections, bypassing normal tissues and capillaries. This can lead to uncontrolled bleeding and, in some cases, death. While AVMs are typically present from birth, they may not be discovered until later in life and can become more apparent after an accident or during puberty. Treatment options include surgery, embolization, and radiosurgery, with the goal of reducing the risk of bleeding and improving the patient's quality of life. Recovery from a ruptured AVM is similar to that of a stroke, and patients often require rehabilitation to regain their physical and cognitive functions.

What is an AVM stroke?

An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels that bypass normal brain tissue and directly divert blood from the arteries to the veins. This can happen anywhere in the brain or on its covering. AVMs can also occur in the spinal cord or elsewhere in the body, such as the lungs, face, arms, legs, heart, liver, or lungs.

In a healthy person, arteries carry oxygen-rich blood from the heart to the brain, and veins carry blood with less oxygen away from the brain and back to the heart. Capillaries, which are tiny blood vessels, act as a bridge between the arteries and veins, slowing down the blood flow and allowing oxygen and nutrients to be delivered to the body's tissues.

However, in people with AVMs, there are no capillaries. This causes the blood to flow directly from the arteries to the veins at a very fast rate (high flow). As a result, the blood does not slow down and is unable to deliver oxygen and nutrients to the body's tissues. This can lead to tissue damage and the death of nerve cells. Over time, some AVMs get progressively larger as the amount of blood flow increases.

The absence of capillaries and the resulting high-pressure blood flow can also cause the veins in an AVM to rupture and spill blood into the brain (hemorrhage), leading to a stroke and brain damage. The chance of a brain AVM bleeding is 1% to 3% per year, and the risk of recurrent bleeding is slightly higher for a short time after the first bleed. The risk of death related to each bleed is 10% to 15%, and the chance of permanent brain damage is 20% to 30%.

AVMs are usually congenital, meaning someone is born with them, but they are typically not hereditary. Brain AVMs occur in less than 1% of the population and are more common in males. Symptoms of AVMs can vary and may include seizures, headaches, pain, visual problems, muscle weakness, problems with speech and movement, abnormal sensations, cognitive difficulties, dizziness, and loss of consciousness.

What are the symptoms of an AVM stroke?

The symptoms of an AVM stroke can vary depending on the location of the malformation. AVMs can occur anywhere in the body, but they most commonly develop in the brain, brainstem, or spinal cord. Here are some of the possible symptoms of an AVM stroke:

• Seizures with or without loss of consciousness
• Muscle weakness or complete paralysis
• Nausea and vomiting
• Numbness or tingling sensation
• Problems with movement, speech, memory, thinking, balance, or vision
• Mental confusion, hallucinations, or dementia
• Back pain or weakness in the lower body, hips, legs, or toes
• Shortness of breath during exertion
• Coughing up blood if the AVM is in the lungs
• Buzzing or rushing sound in the ears
• Headache
• Loss of sensation in part of the body
• Changes in sense of smell
• Loss of consciousness
• Cold or blue fingers or toes

It is important to note that many people with AVMs may not exhibit any symptoms initially. In some cases, the first sign of an AVM may be bleeding, which can lead to a stroke. Therefore, it is crucial to seek medical attention if any of these symptoms are present or if an AVM is suspected.

How is an AVM stroke diagnosed?

An AVM stroke is diagnosed by a healthcare provider who will ask about symptoms and carry out a physical examination. They may listen for a bruit, which is a rapid blood flow sound that can be heard in arteries and veins when there is an AVM.

Imaging tests are then used to detect AVMs. Magnetic resonance imaging (MRI) uses radio waves and a large magnet to detect AVMs. A computed tomography (CT) scan uses X-rays to create a series of images. Catheter angiography involves inserting a tube (catheter) into an artery in the wrist or groin and moving it to the area to be investigated. Dyes and X-rays are used to view the blood vessels in detail.

For brain AVMs, cerebral magnetic resonance angiography (MRA) uses a magnetic field and radio waves to produce detailed pictures of the blood vessels in and around the brain. Computed tomography angiography (CTA) uses X-rays to see detailed pictures of the blood vessels. Transcranial Doppler ultrasound uses sound waves to determine the speed of blood flow through the brain.

An ultrasound is often the first test when an AVM is suspected. It uses sound waves to create a picture of the blood vessels and tissues under the skin and can detect the speed of blood flow. It is a good method for young children as it does not require anaesthesia and is painless.

An MRI gives more detailed pictures of the size and location of an AVM inside the body and can show what other important things, such as nerves, are near the AVM and may be affected by treatment. A CT scan will show whether the AVM is affecting a bone. An angiogram may be ordered to give a very detailed picture of the blood vessels. Angiograms are done under general anaesthesia and can be used to diagnose and "map" the blood vessels in an AVM.

What are the treatment options for an AVM stroke?

Treatment options for an AVM stroke include:

• Surgery to remove the AVM. Surgery involves making a small cut near the AVM, sealing the surrounding arteries and veins so they don't bleed, then removing the AVM. Surgery is a cure for this condition.
• Embolization. In this procedure, a provider inserts a catheter into an artery in your groin or wrist and moves it to the location of the AVM. Once there, they release a glue-like substance, coils or another substance into the AVM, which slows or stops the blood flow through the AVM.
• Gamma Knife® radiosurgery. This approach uses highly focused beams of radiation that slowly shrink, scar and dissolve an AVM over a few years or make the AVM easier to remove with surgery.

What is the recovery process for an AVM stroke?

The recovery process for an AVM stroke depends on the type, size, location, and anatomy of the AVM, as well as the patient's general health. The goal of treatment is to reduce the chance of bleeding or to permanently stop it. Treatment options include open surgery, catheter-based artery blocking, and focused radiation.

Initial Treatment

If you experience an AVM stroke, you will likely be admitted to an emergency department to stabilize your condition and determine the type of stroke. If it is caused by a blood clot (ischemic stroke), clot-busting medication can help reduce long-term effects if administered in time. The severity of the stroke will determine whether you need to spend time in intensive or acute care.

First Few Weeks After an AVM Stroke

The typical hospital stay after a stroke is around five to seven days. During this time, the stroke care team will evaluate the effects of the stroke and develop a rehabilitation plan. The long-term effects of an AVM stroke can include cognitive, physical, and emotional symptoms, heavy fatigue, and trouble sleeping.

Rehabilitation Priorities

Activities of daily living (ADL) become the focus of rehabilitation. These typically include tasks like bathing or preparing food. It is important to work with your care team to set recovery goals that are important to you, such as performing work-related skills or hobbies. While therapy is vital, practicing on your own is equally important.

Leaving the Hospital After an AVM Stroke

Your care team will formulate a discharge plan based on your level of functional impairment. After the hospital stay, you might continue your rehabilitation in an inpatient rehabilitation unit, a subacute rehabilitation facility, or at home with outpatient rehabilitation clinic visits.

1-3 Months Post-AVM Stroke

The first three months after an AVM stroke are crucial for recovery, with most patients entering and completing an inpatient rehabilitation program or making significant progress in outpatient therapy sessions. The goal of rehabilitation is to restore function as closely as possible to pre-stroke levels or develop compensation strategies for any functional impairments.

6-Month Mark and Beyond

After six months, improvements are possible but will be slower. Most stroke patients reach a relatively steady state, with some achieving a full recovery while others experience ongoing impairments, known as chronic stroke disease. Whether a full recovery is achievable depends on factors such as the stroke's severity, the speed of initial treatment, and the type and intensity of rehabilitation.

It is important to continue following up with your care team, which may include a primary care physician, rehabilitation physician, physical and occupational therapists, a neurologist, and a rehabilitation psychologist.

Frequently asked questions