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Vascular malformations of the brain
A guide for patients and carers
What are the symptoms of a vascular malformation?
The symptoms you experience depend on the type of vascular malformation you have, its size and where it is located in your head. Sometimes, vascular malformations cause no symptoms at all.
Brain AVMs can cause strokes, epileptic seizures, headaches, enlarged blood vessels on the scalp and can sometimes lead to symptoms such as memory problems and anxiety or depression. In addition to these symptoms, dural AVMs may also cause problems with vision and pulsing noises in the head, although it is unusual for them to cause epilepsy. Cavernous malformations cause strokes, headaches and epilepsy. It is unusual for venous malformations to cause any
symptoms at all.
Brain AVMs can cause strokes, epileptic seizures, headaches, enlarged blood vessels on the scalp and can sometimes lead to symptoms such as memory problems and anxiety or depression. In addition to these symptoms, dural AVMs may also cause problems with vision and pulsing noises in the head, although it is unusual for them to cause epilepsy. Cavernous malformations cause strokes, headaches and epilepsy. It is unusual for venous malformations to cause any
symptoms at all.
Strokes
Strokes affecting people with vascular malformations are usually due to bleeding (also called haemorrhage) from the thin vessel walls of a vascular malformation. The symptoms of a stroke usually come on suddenly and may be accompanied by headache, nausea, vomiting and
loss of consciousness.
Bleeding is the most serious complication of a vascular malformation,
because of the risk of brain damage and so it is treated as an emergency. Sometimes a bleed may be small and produce no symptoms at all.
Stroke-like symptoms can sometimes occur with no sign of bleeding on a brain scan, perhaps due to pressure changes in the blood vessels, in which case your symptoms may disappear, persist or gradually get worse with time. The main stroke-like symptoms that people experience are weakness or paralysis, loss of feeling or numbness, tingling down one side, difficulty with speech, and problems with balance.
Epileptic seizures
Epileptic seizures can be caused by a vascular malformation pressing on the brain, which causes excessive electrical activity. This makes the part of your brain close to the vascular malformation overactive. You may experience unusual feelings and your muscles may move uncontrollably in the parts of your body controlled by that area of your brain, in which case the seizures are said to be "focal", or "partial". The seizure is "generalised" if it spreads to involve the whole of your body. You may or may not become unconscious during these seizures.
Your doctor may prescribe anticonvulsant medication to try to control the seizures. These tablets need to be taken regularly and you should avoid missing a dose. The dose may be changed according to how frequent your attacks are, and some people will need to take more than one type of drug. More detailed information on epilepsy is available in the Brain and Spine booklet: Epilepsy – A guide for patients and carers.
Headaches
Headaches are a common problem for a large proportion of the population, so it is sometimes difficult to tell whether headaches are related to a vascular malformation or not. People with vascular malformations have headaches that can be similar to migraine, and may respond to the same treatments. People with dural AVMs can get other types of headache due to irritation of pain fibres in the dura mater. When drowsiness, unconsciousness or other stroke-like symptoms accompany a headache you should seek medical attention, because of the possibility of a brain haemorrhage.
Problems with vision
Loss of vision on one side of your field of vision can be a consequence of a stroke. People with a particular type of dural AVM called a carotid-cavernous fistula or "CCF" for short, experience swelling or redness of an eye, in which case the eye may also protrude out of its socket more than normal.
Noises in the head
A dural AVM can cause a noise in your head, called a "bruit", due to the blood flowing through it. Some people may hear this as a distinctive type of ringing in their ears, called "pulsatile tinnitus" – which beats in time with your pulse.
Enlarged blood vessels
People affected by AVMs of the brain or dura may develop prominent veins on their scalp. These are due to the changes in blood flow, caused by the AVM, in the arteries that supply the head and neck.
Memory problems
If you have had a brain haemorrhage, this may leave you with some brain damage that often causes problems with short-term memory, attention and concentration. Even in the absence of bleeding, people with AVMs may report problems with their memory, possibly due to blood flow changes in the brain.
Anxiety and depression
Last, but not least, if you are experiencing anxiety or depression in relation to your vascular malformation, you are not alone. Although these conditions probably do not directly cause changes in how you feel, mood changes are quite common amongst people with vascular malformations. People often find these feelings are difficult or embarrassing to talk about, but your doctor may be able to help.
Strokes affecting people with vascular malformations are usually due to bleeding (also called haemorrhage) from the thin vessel walls of a vascular malformation. The symptoms of a stroke usually come on suddenly and may be accompanied by headache, nausea, vomiting and
loss of consciousness.
Bleeding is the most serious complication of a vascular malformation,
because of the risk of brain damage and so it is treated as an emergency. Sometimes a bleed may be small and produce no symptoms at all.
Stroke-like symptoms can sometimes occur with no sign of bleeding on a brain scan, perhaps due to pressure changes in the blood vessels, in which case your symptoms may disappear, persist or gradually get worse with time. The main stroke-like symptoms that people experience are weakness or paralysis, loss of feeling or numbness, tingling down one side, difficulty with speech, and problems with balance.
Epileptic seizures
Epileptic seizures can be caused by a vascular malformation pressing on the brain, which causes excessive electrical activity. This makes the part of your brain close to the vascular malformation overactive. You may experience unusual feelings and your muscles may move uncontrollably in the parts of your body controlled by that area of your brain, in which case the seizures are said to be "focal", or "partial". The seizure is "generalised" if it spreads to involve the whole of your body. You may or may not become unconscious during these seizures.
Your doctor may prescribe anticonvulsant medication to try to control the seizures. These tablets need to be taken regularly and you should avoid missing a dose. The dose may be changed according to how frequent your attacks are, and some people will need to take more than one type of drug. More detailed information on epilepsy is available in the Brain and Spine booklet: Epilepsy – A guide for patients and carers.
Headaches
Headaches are a common problem for a large proportion of the population, so it is sometimes difficult to tell whether headaches are related to a vascular malformation or not. People with vascular malformations have headaches that can be similar to migraine, and may respond to the same treatments. People with dural AVMs can get other types of headache due to irritation of pain fibres in the dura mater. When drowsiness, unconsciousness or other stroke-like symptoms accompany a headache you should seek medical attention, because of the possibility of a brain haemorrhage.
Problems with vision
Loss of vision on one side of your field of vision can be a consequence of a stroke. People with a particular type of dural AVM called a carotid-cavernous fistula or "CCF" for short, experience swelling or redness of an eye, in which case the eye may also protrude out of its socket more than normal.
Noises in the head
A dural AVM can cause a noise in your head, called a "bruit", due to the blood flowing through it. Some people may hear this as a distinctive type of ringing in their ears, called "pulsatile tinnitus" – which beats in time with your pulse.
Enlarged blood vessels
People affected by AVMs of the brain or dura may develop prominent veins on their scalp. These are due to the changes in blood flow, caused by the AVM, in the arteries that supply the head and neck.
Memory problems
If you have had a brain haemorrhage, this may leave you with some brain damage that often causes problems with short-term memory, attention and concentration. Even in the absence of bleeding, people with AVMs may report problems with their memory, possibly due to blood flow changes in the brain.
Anxiety and depression
Last, but not least, if you are experiencing anxiety or depression in relation to your vascular malformation, you are not alone. Although these conditions probably do not directly cause changes in how you feel, mood changes are quite common amongst people with vascular malformations. People often find these feelings are difficult or embarrassing to talk about, but your doctor may be able to help.
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Page 7 of 15
Contents
- Introduction
- What is a vascular malformation of the brain?
- Arteriovenous malformation (AVM)
- Cavernous malformation
- Venous malformation
- What tests will the doctors do?
- What are the symptoms of a vascular malformation?
- What are the risks for the future?
- How can vascular malformations be treated?
- What is embolisation?
- What is stereotactic radiosurgery?
- What is neurosurgery?
- What other treatments might I have?
- How will my life be affected?
- Other organisations that may be able to help
