Diagnosis
To diagnose a central nervous system vascular malformation, a healthcare professional looks for a family history of stroke, epilepsy or related conditions. You may have a physical exam, and your healthcare professional may listen to the sound of blood flow in one of your arteries with a stethoscope. Some vascular malformations make a whooshing sound called a bruit. Fast blood flow through a malformation causes the bruit.
Imaging tests
Imaging tests can detect a central nervous system vascular malformation. A magnetic resonance angiogram or a computerized tomography angiogram might be used to diagnose a central nervous system vascular malformation and plan treatment.
An angiogram shows blood flow through arteries or veins. A contrast material is put into the blood through an IV. The contrast lights up blood vessels on the angiogram image.
Some vascular malformations, such as cavernous malformations, are found using regular MRI or CT scans.
Treatment
Treatment of a central nervous system vascular malformation depends on:
- The type of malformation.
- Where it's found.
- Symptoms it causes.
- The risk of the malformation bleeding.
Sometimes, watching for changes in the malformation might be all that's needed.
Medicines
Medicines to treat the symptoms of venous malformations include antiseizure medicines to treat seizures and pain relievers for headaches.
Surgery or other procedures
Some central nervous system vascular malformations that are very likely to bleed may be removed with surgery. The procedure depends on the malformation.
-
Surgery involves cutting into the brain or spinal cord to remove the malformation. Surgery is often used for an arteriovenous malformation that is small and in a place that's easy to reach.
As with any surgery, there are risks, such as infection and blood loss. There's also a risk of damaging nearby healthy tissue.
-
Stereotactic radiosurgery uses radiation beams aimed at the vascular malformation. The radiation damages the walls of the blood vessels that form the malformation. This causes the malformation to go away over time.
Because radiosurgery doesn't involve cutting, the risks are lower than with standard surgery. However, there's a risk of radiation damage to healthy tissue.
-
Endovascular embolization involves using a long, thin tube called a catheter. The tube is put into an artery in the leg or groin that feeds the malformation. It's then threaded to the brain using X-ray imaging to guide it.
The surgeon sends coils or a gluelike substance through the tube that blocks the artery and lowers blood flow to the malformation.
Embolization often is used with other surgical procedures. It might not completely remove the malformation, or the results might not last long.
Preparing for your appointment
If you have symptoms of a central nervous system vascular malformation, you might start by seeing your primary care provider. Or you might learn you have a malformation after having imaging tests for another condition. You might then be referred to a doctor who specializes in conditions of the nervous system, called a neurologist.
Here's some information to help you get ready for your appointment.
What you can do
When you make the appointment, ask if you need to do anything in advance, such as fasting before having a specific test. Make a list of:
- Your symptoms. Include any that seem unrelated to the reason for your appointment and when they began.
- Key medical information. Include personal and family medical history.
- All medicines, vitamins or other supplements you take. Include doses.
For central nervous system vascular malformations, basic questions to ask your healthcare professional include:
- What's likely causing my symptoms?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What's the best course of action?
- What is my risk of having complications from this condition?
- I have other health conditions. How can I best manage them together?
- Are there brochures or other printed material I can have? What websites do you recommend?
Be sure to ask all the questions you have about your condition. If possible, bring a family member or friend to your appointment to help you remember the information you're given.
What to expect from your doctor
Your health professional is likely to ask you questions such as:
- How often do your symptoms happen?
- How painful are your symptoms?
- What, if anything, seems to make your symptoms better?
- What, if anything, seems to make your symptoms worse?