Cerebral Arteriovenous Fistula - Symptoms & Causes

What is a cerebral arteriovenous fistula?

An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein.

In a normal circulatory system, blood flows from arteries into capillaries, where it delivers oxygen and nutrients to tissues before moving into veins that return it to the heart. In an AVF, blood bypasses the capillaries and flows directly from an artery into a vein, disrupting normal circulation. This can lead to various complications as tissues may not receive adequate oxygen and nutrients.

AVFs can occur naturally (congenital) or result from an injury or surgical procedure. They are often created deliberately for dialysis patients to facilitate easy and repeated access to the bloodstream.

AVFs can happen anywhere in the body, but here we cover AVFs in the brain, known as cerebral AVFs.

What are the symptoms of a cerebral arteriovenous fistula?

Symptoms of an arteriovenous fistula can vary depending on its size and location. Some symptoms include:

  • Hemorrhagic stroke due to AVF bleeding can result in headaches, weakness, or numbness.
  • Seizures.
  • Ringing sounds known as tinnitus or sounds of pulsatile flow known as pulsatile bruit.
  • Neck or back pain.

What causes a cerebral arteriovenous fistula?

The causes of a cerebral arteriovenous fistula include:

  • Congenital defects. Some individuals are born with AVFs due to abnormal vascular development during fetal growth.
  • Trauma. Injuries that penetrate the skin, such as knife or gunshot wounds, can lead to the formation of an AVF.
  • Surgical procedures. AVFs are often created surgically for patients undergoing hemodialysis to provide a robust blood flow that can be accessed repeatedly for dialysis.
  • Medical conditions. Conditions such as aneurysms or vascular malformations can lead to the development of AVFs.

An arteriovenous fistula can lead to several complications if left untreated:

  • Heart failure. The abnormal blood flow can strain the heart as it tries to compensate for the altered circulation, potentially leading to heart failure.
  • Bleeding. The veins connected to arteries are not equipped to handle high pressure, increasing the risk of bleeding.
  • Blood clots. The turbulent blood flow can lead to clot formation, increasing the risk of deep vein thrombosis (DVT) or pulmonary embolism.
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