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. 2021 Oct 9;22(1):122.
doi: 10.1186/s10194-021-01331-6.

Angioarchitectural features amongst patients with unruptured brain arteriovenous malformations presenting with headache: findings from a single center retrospective review of 76 patients

Benjamin N Africk  1 , Daniel M Heiferman  2 , Amy W Wozniak  3 , Faraz Behzadi  4 , Matthew S Ballard  4 , Joshua M Chazaro  4 , Brandon M Zsigray  5 , Rachyl M Shanker  5 , Matthew R Reynolds  5 , Douglas E Anderson  5   6 , Joseph C Serrone  7   8   9
Affiliations

Angioarchitectural features amongst patients with unruptured brain arteriovenous malformations presenting with headache: findings from a single center retrospective review of 76 patients

Benjamin N Africk et al. J Headache Pain. .

Abstract

Background: Brain arteriovenous malformations (AVMs) consist of abnormal connections between arteries and veins via an interposing nidus. While hemorrhage is the most common presentation, unruptured AVMs can present with headaches, seizures, neurological deficits, or be found incidentally. It remains unclear as to what AVM characteristics contribute to pain generation amongst unruptured AVM patients with headaches.

Methods: To assess this relationship, the current study evaluates angiographic and clinical features amongst patients with unruptured brain AVMs presenting with headache. Loyola University Medical Center medical records were queried for diagnostic codes corresponding to AVMs. In patients with unruptured AVMs, we analyzed the correlation between the presenting symptom of headache and various demographic and angiographic features.

Results: Of the 144 AVMs treated at our institution between 1980 and 2017, 76 were unruptured and had sufficient clinical data available. Twenty-three presented with headaches, while 53 patients had other presenting symptoms. Patients presenting with headache were less likely to have venous stenosis compared to those with a non-headache presentation (13 % vs. 36 %, p = 0.044).

Conclusions: Our study suggests that the absence of venous stenosis may contribute to headache symptomatology. This serves as a basis for further study of correlations between AVM angioarchitecture and symptomatology to direct headache management in AVM patients.

Keywords: arteriovenous malformation; headache; venous ectasia; venous stenosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Bar graph representation of angioarchitectural characteristics demonstrated in headache and non-headache presentations of unruptured AVMs. ** indicates significant findings.
Fig. 2
Fig. 2
Representative imaging and disease course of three patients with headache and AVM draining vein stenosis. (A) 51-year-old male presenting with new headaches and Spetzler-Martin grade 3 right frontal AVM with stenosis of the mid-portion of the dominant draining cortical vein (arrow). Patient underwent embolization and stereotactic radiosurgery. (B) 11-year-old female presenting for severe headaches (with emesis) and right facial droop. Angiogram reveals Spetzler-Martin grade 3 right basal ganglia AVM. She was treated with stereotactic radiosurgery and shortly thereafter suffered a hemorrhagic complication. The angiogram shows 50 % stenosis of the deep drain vein (arrow). Patient underwent another stereotactic radiosurgery after which she no longer experienced severe headaches. (C) 44-year-old female presenting with headache and confusion. Angiogram findings include Spetzler-Martin grade 2 right posterior temporal AVM with cortical venous stenosis just proximal to the cortical vein entering the superior sagittal sinus (arrow). Patient underwent successful embolization and surgical resection with only dull headaches noted after the procedure.
See this image and copyright information in PMC

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