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Arteriovenous Malformations - Negligence
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Arteriovenous malformations or AVMs are clusters of abnormal blood vessels that occur during the embryonic or fetal development. They are made from a tangle of veins and arteries that means that arterial blood goes straight to venous blood without being used up by the system and going through the lungs. The most dangerous AVMs are located in the brain or spinal cord and can have widespread implications.
The symptoms of an arteriovenous malformation can be nothing at all or can be related to the location of the AVM. They are often found only at autopsy. About twelve percent of the affected people with AVMs there are actual symptoms. They can even be debilitating in rare cases.
The most common symptoms of AVMs include seizures or headaches. Headaches can be mild or severe and can be generalized or localized to the site of the AVM. There can be a wide variety of symptoms related to where the AVM is located. These can include partial paralysis, ataxia (poor balance and unusual gait), dizziness, visual field defects, difficulty speaking, paresthesias (unusual sensations), and dementia. AVMs can even cause subtle learning deficits in younger children.
Doctors can diagnose an AVM by listening to a bruit or whooshing sound overlying the suspected area. This occurs when the Arterial blood rushes into the veins. The bruit may compromise a person's hearing and can disturb the sleep.
Symptoms can occur at any age but because they tend to gradually worsen over time, the symptoms often aren't noticed until the age of twenty or more. AVMs past the age of forty tend to be completely stable and won't show side effects after that time unless they already yield side effects. They can change over time, especially if a woman is pregnant or if the person has high blood pressure.
There is one severe type of AVM that occurs within the brain and is associated with the vein of Galen. It is associated with hydrocephalus (fluid on the brain), seizures, failure to thrive and CHF (heart failure). Such children do not usually survive past their infant years and are impaired developmentally.
AVMs can occur just about anywhere in the brain and spinal cord, including the coverings of the brain. The AVMs that can affect the spinal cord can involve the dura of the spinal cord and can involve the spinal cord itself. Spinal cord AVMs can cause sudden, excruciating back pain. It feels exactly like a slipped disc. Degeneration of the spinal nerves is possible and very debilitating.
AVMs of the covering of the brain can occur at any place in the brain surface. They can damage thinking, the understanding of language, speaking, hearing, touch, taste or voluntary movements. Visual disturbances can also happen. Remember that AVMs can also affect the deep portions of the brain, affecting the thalamus, basal ganglia and hippocampus, which controls memory. Even the cerebellum can be affected so that balance and coordination are impaired. If the brainstem is involved, it can affect breathing and the function of the heart.
The diagnosis of AVMs can be done using CT scan and MRI scans, showing the AVM. An angiogram can show the presence of the arterial and venous components of the AVM. The structure of the AVM is identified using regular x-rays. A catheter can be used to identify the exact artery affected by the AVM.
The treatment of AVMs can be symptomatic and can control the pain and seizures that can be caused by the AVM. This includes pain medications for back pain and anti-seizure medications. Surgery can rarely be used to get rid of the AVM. Surgery is difficult because the AMV is often not well defined and the surgery may remove much normal tissue to get at the AVM. The risks and benefits must be weighed before the decision to have surgery is made.