About the disease
Av-malformation of brain is an abnormal tangle of abnormal blood vessels that connect the arteries and veins in the area of the brain. Overall, arteries are responsible for the transportation of blood from heart to brain Moreover, this blood must be rich in oxygen, that's why arteries contain special oxygen-cells. Blood which does not have an oxygen is carried to lungs and back to the heart, because brain can naturally accept only oxygen-cells blood. In case av-malformation this process of blood interchange becomes disrupted. It means that blood with oxygen and blood without oxygen mix and create chaos. Av-malformation can develop in any part of the body, but most often if effects brain and spine. Brain av-malformation is very rare disease with 1% of world population having it.
Cause of brain malformation still remains unknown. It is a congenital disease, but it manifests itself when a person is in his adulthood. It is not transmitted genetically, which means that this disease appears absolutely randomly.
First symptoms of av-malformation may appear at the age of 11-12. Some patients begin to feel the rupture of brain tissues only when they are 40 or 50. Symptoms gradually build up and become more and more severe over the course of several years. Sometimes brain malformation manifests itself during pregnancy, when a woman suddenly experiences hemorrhage of brain tissues and severe headaches. Nevertheless, brain malformation is more common in men that women. According to Brain Foundation.org, which is a medical site, if the first symptom of this disease was hemorrhage, it can become fatal in 10%. That`s why timely treatment is so important.
Symptoms
- Hemorrhage of the brain vessels
- Rupture of certain brain tissues
- Constant pain in one specific area of the head
- Some muscles become weak and can not function as before
- Body becomes numb
- Patient may lose vision partially or fully
- Coordination becomes unsteady and unbalanced
The most dangerous type of brain malformations is called the Galen defect. This defect is inborn and it can appear either after the birth or during the first months of baby`s life. If the person has the Galen effect, the blood vessels start to accumulate in his rain to the point when the head swells enormously. The swelling is especially seen on the scalp and near the neck. Because of this swelling brain experiences compression and the fluid, which was earlier directed in specific areas of the brain, starts to freely flow in any part of the hemisphere. The Galen defect may also cause various heart diseases, because the blood does not return properly back to the heart.
Diagnosis
The most common diagnostic method for this disease is brain scan. Doctors may also use the cerebral arteriography during which the location of arteries is revealed. Magnetic imaging can also be quite effective. It helps to obtain the microscopic image of the brain with its smallest deviations from the norm. It can also detect if there`s an excessive amount of blood in the brain.
Treatment
The most dangerous complication of brain malformation is the brain hemorrhage, that`s why treatment of malformation mostly aims to prevent or stop bleeding and future seizures. Medicine in this case may only alleviate the pain and reduce the number of headaches, that's why it's important to undergo surgery. There are such surgical options:
- Partial resection and coiling, when a doctor inserts catheter into hip vessel to pack coils into aneurysm. It is done to prevent blood flow from inundating aneurysm. The doctor can track the catheter through the X-Ray which shows its exact location. Coiling may reduce size of the malformation and prevent further bleeding.
- Platinum coils embolization (coiling) is a more modern procedure, which also uses coils to hamper blood flow, but in this case doctor uses coils made of platinum.
- Resection of AVM. During the resection the surgeon makes an incision and opens a skull. After that he identifies the exact location of the damaged brain tissue and removes the malformation around this. If the malformation is located too deep, neurosurgeon simply can not reach it and in that case he can use other treatment options.
- Radiosurgery. During the radiosurgery the doctors use radiation to destroy the malformation. In this case the irradiation scatters damaged cells. If malformation is too big, it is impossible to make the cells vanish. The biggest drawback of radiosurgery is that the cells, which formed the malformation before, may gather again and create even a bigger problem. Moreover, the irradiation has a long line of serious side effects: the immune system of the person weakens, he loses his hair, his skin worsen and general health condition deteriorates. That`s why it is more preferable to undergo the surgery. Recent advances in medicine allow the doctors to almost diminish the malformation with the microsurgery, which can reach the most distant cells and prevent their future growth. The most modern type of radiosurgery is Gamma Knife, which is less traumatic than surgery.
After treatment was finished patients need to undergo the regular check-ups and to maintain the healthy lifestyle. For instance, patients are advised to undergo course of physical therapy and to avoid any stressful situations in future, which can cause the hemorrhage of the bain. Patients also need to regularly control their blood pressure. If it is high, they are prescribed drugs that can normalize the blood flow and prevent hypertension.
Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed
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