1
- Tangle of abnormal blood vessels connecting arteries and veins in the brain
- Disrupts blood flow process
- Can develop anywhere in the body
- Most often in the brain or spine
- Affect <1% of the population
- Cause - unknown
- Most born with - can occasionally form later in life
- Commonly found after a brain scan for another health issue or after the hemorrhage
- Can often be treated successfully to prevent complications
Arteriovenous malformation (AVM)
In middle aged people, AVMs tend to remain stable and are less likely to cause symptoms UNLESS the person has _______.
HTN
Symptoms of AVM can occur at any range, usually emerge between what age ranges?
10-40 yo
T/F: Pregnant women may have increased symptoms due to changes in blood volume and blood pressure?
True
- Intracerebral hemorrhage
- Can go undetected/cause no major brain damage or symptoms
- Potentially life threatening bleed
- Brain AVMs - 2% of all hemorrhagic strokes each year
- Children and young adults who experience brain hemorrhage
- Reduced oxygen to brain tissue
- Think or weak blood vessels - Aneurysm may develop and become susceptible to rupture
- Brain damage
- Hydrocephalus
- Seizures
Complications of AVM
Do AVM symptoms/effects come on slowly or quickly?
Slowly build up and often cause symptoms in early adulthood
- no s/s
- 50%: hemorrhage is the first sign
- Seizure
- hydrocephalus
- Muscle weakness or numbness in one part of the body
- Severe headache
- weakness, numbness or paralysis
- vision loss
- difficulty speaking
- confusion or inability to understand others
- severe unsteadiness
Symptoms of AVM
- Cerebral arteriography/cerebral angiography (most detailed test to diagnose)
- CT scan (shows subtle changes in brain tissue associated with AVM)
- MRI (provides exact location of the malformation and any related bleeding in the brain)
Tests used to diagnose brain AVMs
What is the most common treatment for AVM?
Surgery
What is the goal on treatment in AVM?
Prevent hemorrhage, seizures or other neurological complications
- Based on age, health, and the size of the location of the abnormal blood vessels
- Medications to treat symptoms - headaches or seizures
- Endovascular embolization - redirecting blood back to normal brain tissue
- Gamma Knife targeting
- Stereotactic radiosurgery - precisely focused radiation to destroy the AVM
- Surgery - most common tx
Treatment for AVM
- General categorization that describes any injury to the brain that occurs after birth
- Trauma
- Head injury (traffic incidents, falls)
- Anoxia (near-drowning, hangings)
- Nontraumatic event
- Stroke
- Brain tumor
- Infection
- AVM
- Most common cause of morbidity and mortality in children and in young adults
Acquired brain injury
- Highly stressful event for the child and the family
- Time of development affects abilities to do what children usually do
- Play
- Learn
- Establish friendships
- Gradually develop to become independent young adults
- Variety of physical, emotional, cognitive, and behavioral impairments
- Childs expectations from life and the parents aspirations for their child may be dramatically changed
- Unique emotional, social, and developmental needs of the child and family
- Holistic and inclusive approach by a multidisciplinary team
Acquired brain injury in children
What is the most common cause of acquired disability in childhood?
TBI
- Born with AVM, much more focal, do not meet standards for funds
- Acquired brain injury: has to be external force, brain and spinal cord trust fund has to be acquired
Difference between AVM and acquired brain injury
Variety of disorders involving
- Motor dysfunction
- Cognitive impairment
- Behavioral disturbance
- Emotional difficulties
- Abnormal function of the autonomic nervous system
Even a mild injury might result in a serious disability that interferes with the childs daily functioning and activities for the rest of his or her life.
Acquired brain injury
What is the most frequent causes of injury in children 15-20 yo?
Motor vehicle accidents
- Incidence highest in boys between the ages of 15 and 20 yo
- Increased risk include:
- Poverty
- Crowded neighborhoods
- Family instability
- History of alcohol or drug abuse
- Learning disability
- Pre-existing behavioral characteristics
- Impulsivity
- Hyperactivity
- Attention deficit disorder
Epidemiology of TBI
- From vigorous shaking of an infant or small child by the shoulders, arms, or legs
- Preventative efforts are essential and should include educational programs for children, adolescents, and parents.
- All babies cry!
- Safer in crib than with frustrated or emotionally unstable caregiver
- Presents like TBI (coup contracoup injury)
- Do not have good outcomes -- part of that comes from social dynamics before and after injury
Shaken baby syndrome
What is the most frequent cause of injury (TBI) in younger children?
Falls
Infection
- After an open fracture or CSF rhinorrhea
- Iatrogenic - caused by intracranial monitoring or surgery
Hydrocephalus
Hygroma - develops as the result of localized CSF collection
Posttraumatic seizures
Further brain damage
What are the (3) seizure precautions?
1. No roller coasters
2. No driving
3. No blinking lights 6 months after last seizure
- No single factor adequately predicts outcome
- Severity of the brain injury seems to be directly associated with the outcome
- GCS
- Coma duration
- PTA
Prognosis after TBI
Name the three types of post-traumatic seizures
1. Immediate seizures = within minutes
2. Early seizures = within 1 week of the trauma
3. Late seizures = beyond the first week of injury
- Two or more late seizures is diagnosed as having posttraumatic epilepsy
- Period of variable length after trauma, during which the patient is confused and disoriented
- Retrograde amnesia: inability to remember and recall new information
- Longer the period, the worse the outcome
- Unlikely outcome of severe disability if duration is less than 2 months
- Unlikely that a person will have good recovery if duration is > 3 months
Post-traumatic amnesia (PTA)