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Brain abnormality AVM rare but potentially life-threatening

Medical researchers do not know exactly what causes a brain AVM (arteriovenous malformation) to develop, but "there are a lot of theories," said Dr. Alexander Drofa, an endovascular neurosurgeon who is completing fellowship training at Cleveland Clinic in Ohio and plans to join Sanford Health in Fargo next month.

A brain AVM is an abnormal tangle of arteries and veins that can rupture and cause bleeding in the brain, which can lead to various physical and neurological problems.

"It is generally thought that it usually forms in utero—while the baby is in the womb—in the third or fourth week of gestation," Drofa said.

It can cause severe headaches, seizures, vision loss, difficulty speaking, confusion or inability to understand others and muscle weakness or numbness in one part of the body.

AVMs are "quite rare," Drofa said. Only about 20 in 100,000 adults are affected.

Complications are more likely to affect younger adults, he noted.

"About 40 to 50 percent of people who have an intracranial hemorrhage (bleeding in the brain) not caused by trauma, in the 15- to 45-year age range will have an AVM," he said.

"Unfortunately, the majority of AVMs are identified by hemorrhage."

An AVM "can grow and press on surrounding brain tissue," he said. "If severe, it can cost you your life."

Many describe their headache as the worst of their life, he said.

AVMs can be detected by high-tech imaging equipment, such as a CT (computer tomography) scan, catheter angiogram or MRI (magnetic resonance imaging), Drofa said.

"If you have an AVM, you have a 2 to 4 percent risk of hemorrhage each year."

A person can live a lifetime without experiencing any symptoms caused by an AVM in his or her brain, he said. In such cases, the conservative management approach would be to monitor it.

AVMs should not be confused with aneurysms, which "are completely different," Drofa said.

"An aneurysm affects a cerebral (brain) vessel in the brain. Pressure creates a weak spot in the vessel and is prone to rupture."

"Aneurysms are five to seven times more common than AVMs," he said.

Responding

Some symptoms of AVM rupture may appear similar to those that occur with a stroke.

Anyone who is exhibiting symptoms that are typical of a stroke should be taken immediately for emergency care and evaluation, Drofa said.

The National Stroke Association used the acronym "FAST" to help members of the public remember to respond to:

F - Face: Ask the person to smile; if one side of the face appears crooked or drooping, this person may be having a stroke.

A - Arms: Ask the person to lift both arms in the air; if he or she has difficulty with one arm, this too might be a sign that this person is having a stroke.

S - Speech: Ask the person to speak; if his or her words are slurred or they are unable to speak, they might be having a stroke.

T - Time: If any of the above symptoms are present, you must call 911 immediately in order to make sure that this person reaches the hospital fast.

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