March 3, 2024

Hemorrhagic stroke or a bleed in the brain is one of the complications of an arteriovenous malformation (AVM). This bleed can lead to sudden seizures or sudden collapse.
In normal blood circulation, blood passes from an artery through smaller arterioles to a network of small capillaries and then to a vein. Movement of blood is smooth and gradual, allowing release of oxygen from the arteries to the tissues before blood enters the veins.
In an AVM, the arteries connect directly to veins, leading to the formation of an abnormal tangle of blood vessels where blood flow is more rapid and tissue oxygenation is compromised. With entry of blood or fluid and increase in pressure inside the AVM, a blood vessel wall may weaken, rupture and bleed. In about 50 percent of AVM in the brain, bleeding is the first sign.
AVM can occur in any part of the body but common sites are the brain, the brainstem and the spinal cord. AVMs occur in about one in 100,000 people. The sizes and the locations vary.
The cause of these blood vessel malformation is not known but it is believed that most are present at birth. They form during development inside the womb when the fetus is about eight weeks. Rupture and bleeding of AVM is a common cause of stroke in persons aged 20 to 40 years old.
The symptoms depend on where the AVM is located. It can be asymptomatic at first but as blood and pressure builds up inside the tangle of blood vessels the size of the AVM may increase and the person will experience headache, muscle weakness, or numbness in one part of his or her body. Severe signs and symptoms include paralysis, loss of vision, speech difficulty, confusion, and unsteadiness.
Diagnosis of AVM is usually made on imaging with CT scan, magnetic resonance imaging (MRI) and/or angiography. These procedures are done in situations when a person presents with signs or symptoms. An AVM may also be an incidental finding
Routine screening for AVM among family members of patients with AVM is not advised because the disease is not hereditary.
Treatment of an AVM is individualized. Decision is based on several factors like a patient’s age, co-existing medical problems, the features of the AVM like its size and location. The options are conservative medical management, surgical removal, or stereotactic radio surgery. A method called endovascular embolization involves the use of microparticles and cyanoacrylates.
Surgery removes the AVM. In radiosurgery, the site of the AVM is irradiated to reduce the risk of a bleed. In embolization the agents used will block the blood vessel that feeds blood to the AVM.


Gratitude is a thankful appreciation for everything that we receive in life. The attitude of gratefulness is associated with joy and happiness. Studies have shown that it improves our health and general well-being. During this season of Advent, allow me to share a list from Fr. Angelo Paolo Asprer who led the recent Advent Recollection of Notre Dame de Chartres Hospital on being “Grateful, thankful, and blessed” :

  1. Keep a gratitude journal. Set aside time to list all the graces you receive each day.
  2. Remember how we survived the bad.
  3. Ask not only, “What have I received but what have I given? A truly grateful person is a generous person.
  4. Learn prayers and rituals of gratitude.
  5. Come to your senses.
  6. Use visual reminders. Open your eyes and see reminders of gratitude. Focus on what really is essential. No matter how imperfect things can become there is always something to be grateful for.
  7. Make a vow to practice gratitude. Gratitude is the best antidote to envy.
  8. Watch your language.
  9. Think outside the box.

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