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Cerebral Arteriovenous Malformations
Submitted by Anthony Chang, MD

General Considerations

  • True AVMs contain at least one enlarged feeding artery and at least one enlarged early draining vein.
  • These vessels arise congenitally during fetal life and can be supplied from any cerebral vessel.
  • Superficial AVMs may be supplied from the external carotid artery with a dural component.
  • The AVM complex begins with the dilated feeding artery to the core/nidus (vascular cluster of entangled vessels) to enlarged draining veins

CT findings

  • Vascular tangles are serpiginous and hyperdense without contrast from the blood pool effect.
  • AVMs may contain punctate or curvilinear calcification.
  • AVMs will enhance

MRI findings

  • Curvilinear flow voids
  • MRA for mapping


  • Should demonstrate the three components of the enlarged feeding artery, core/nidus, and enlarged draining vein.
  • Smaller AVMs may simple demonstrate early venous filling during the arterial phase of enhancement

Associated syndromes

  • Sturge Weber
  • Wyburn Mason
  • Klippel-Trenaunay-Weber
  • Osler Weber Rendu


  • Hemorrhage
  • Steal phenomenon where blood supply is preferentially delivered to AVM at the cost of normal brain parenchyma and can lead to focal neurological symptoms, seizure and focal atrophy.
  • Aneurysms can form and become a source of hemorrhage


  • Endovascular embolization
  • Surgery
  • Radiation therapy

 cerebral avm

Cerebral Arteriovenous Malformation. Unenhanced (top) and enhanced (bottom) axial CTs of brain shows a large, serpiginous AVM in the left parietal lobe adjacent to the tentorium.

The Requisites: Neuroradiology 2nd edition, Grossman and Youssem