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Arteriovenous Malformation (AVM) - Diagnosis and Evaluation

A brain AVM may be diagnosed in an emergency, after a hemorrhage (bleed) has occurred. If you find yourself in an emergency situation, you will be treated by a neurosurgeon. All neurosurgeons are trained in the treatment of AVMs.
 In some other cases, it may be suspected because the patient is exhibiting symptoms suggestive of an Arteriovenous Malformation .
Your examining doctor will begin with questions about your symptoms. Typical questions in diagnosing an AVM include:

  • When did you first begin experiencing Symptoms? 
  • Are the symptoms intermittent or continuous?
  • How severe are the symptoms? 
  • Does anything imrprove the symptoms?
  • Does anything make the symptoms worse?

If the neurosurgeon suspects a brain AVM, there are three principal tests that may be used in diagnosis.

Cerebral Arteriography.
This is the most detailed and preferred method of diagnosing an AVM. Typically a thin tube is inserted into the femoral artery in the groin and then carefully threaded through the circulatory system to the carotid artery. A dye (contrast agent) is then added to the blood vessels in the brain and X-rays are taken. This procedure is also referred to as a cerebral angiography.  An AVM will show up as a tangle of blood vessels. The test will show the location, size, and nature of the involved arteries and veins.

Computerized tomography (CT).
A computerized tomography (CT) scan takes pictures of the brain using X-rays. The test may be done with or without a dye (contrast agent). CT scanning is well suited to detecting bleeding into the brain or the fluid spaces around the brain.  Some research has suggested an increased lifetime risk of cancer, however the clinical benefit of performing the procedure must always be taken into account.

Magnetic resonance imaging (MRI).
Magnetic resonance imaging (MRI), more sensitive than CT in showing the AVM, creates images using a large magnet and radio waves. MRI also provides information about the exact location of the malformation, which is very important for determining treatment options. Dye can also be injected to better see the blood circulation in the brain. This is called a magnetic resonance angiogram (MRA). MRI examination shows in detail the AVM and it relationship to the brain.

You should seek immediate care if you notice signs or symptoms of a brain AVM. A “brain bleed” should be considered a life-threatening emergency situation.

In nonemergency settings, AVMs can be evaluated and diagnosed by a Princeton Brain and Spine Care Physician.  If you would like an evaluation, call for an appointment at one of our 4 convenient locations.  If however you are in an urgent situation, we recommend the following facilities that can handle these types of problems in an emergency setting.

IN NEW JERSEY: Robert Wood Johnson University Hospital in New Brunswick or Morristown Memorial Hospital in Morristown.
IN PENNSYLVANIA: St. Mary Medical Center in Langhorne and University of Pennsylvania in Philadelphia.  

Experts in this area of neurosurgery include:
IN NEW JERSEY: Dr. Gaurav Gupta, Director of Cerebrovascular Neurosurgery at Robert Wood John University Hospital
IN PENNSYLVANIA: Dr . Michelle Smith, Director of Cerebrovascular Neurosurgery at University of Pennsylvania.


LastUpdate: 2016-05-11 17:24:44


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