A University of Georgia student, Liza Burke, experienced a seemingly random brain bleed earlier this month during her Spring break vacation in Mexico after complaining of a headache, according to recent news reports. What followed sheds light on a rare disorder.

NC woman who suffered brain hemorrhage while on spring break in Mexico diagnosed with tumor. WSOC TV.

 

A family friend of Burke’s told WSBTV, “She started to have a headache, so she said ‘I’m going to go back to the room to lay down and take some medicine.’ Her friends went back later to check on her and they couldn’t wake her up.” News reports say Burke described the headache as a migraine.

Burke has since been hospitalized and is on life support after receiving surgery. She was initially diagnosed with a previously unknown condition—​​Arteriovenous Malformation (AVM).

Her story sheds light on AVM and other neurological conditions, which are often thought to not impact young people.

 

What is ​​an Arteriovenous Malformation (AVM)?

 

An arteriovenous malformation (AVM) is a vascular mass made up of differently-sized, enmeshed blood vessels, in which direct connections are made between the arterial and venous circulations, explains Walavan Sivakumar, MD, board-certified neurosurgeon and director of neurovascular surgery at Pacific Neuroscience Institute in Santa Monica, CA.

Specifically, AVMs are rooted in the mixing of arteries carrying high-pressure blood with veins transporting low-pressure blood. This direct connection can lead to AVM ruptures and aneurysms.

Arteriovenous malformation symptoms & treatment | pacific stroke & neurovascular center. Pacific Stroke and Neurovascular Center.

 

Eighteen out of 100,000 people in the United States have an AVM in the brain, says the Brain Aneurysm Foundation (BAF)—with only one of 100,000 having been officially diagnosed (typically between the ages of 20 and 60). AVMs can sometimes be found during a routine examination (in five-10 percent of cases).

Arteriovenous malformation. Brain Aneurysm Foundation.

However, in about half of patients with AVM, the condition is found after the patient has already had a hemorrhage or stroke. 

 

Both males and females are equally at risk for AVM, and between 10 to 60 percent of patients with AVMs have had at least one aneurysm. AVMs can occur anywhere in the body, but they’re commonly found in the brain, according to BAF. AVMs aren’t fully understood—but experts think they’re a congenital condition. Some AVMs, however, are developed after birth. They’re not inherited, although people with Hereditary Hemorrhagic Telangiectasia (HHT), which is an inherited condition, are at 10,000 times the risk for AVM.

 

AVM symptoms, diagnosis, & treatment

 

“AVMs are typically asymptomatic prior to rupture….and often come on suddenly,” Sivakumar says.

Symptoms can include a severe headache; in fact, one study found that a majority of people with AVM experienced a holocranial headache.

Garcia-Espinosa P, Botello-Hernández E, Torres-Hernández G, Guerrero-Cavazos C, Villareal-Garza E, Flores-Rodriguez A. Predictors of cerebral arteriovenous malformation mortality: a single-center, five-year retrospective study. International Journal of Medical Students. 2021;9(3):213-218.

Other symptoms include nausea, vomiting, photophobia, weakness, confusion, fainting, loss of consciousness, and seizures.

Arteriovenous malformation symptoms & treatment | pacific stroke & neurovascular center. Pacific Stroke and Neurovascular Center.

Some symptoms are stroke-like, which may include challenges seeing, moving, and speaking.

Arteriovenous malformation. Brain Aneurysm Foundation.

 

 

According to Clinical Case Reports, AVMs are diagnosed via clinical examination and imaging (especially MRI, but also angiogram and CT scan).

Litaiem N, Tabka M, Nefiss M, Slouma M, Ben Slama S, Zeglaoui F. Cutaneous leiomyosarcoma mimicking arteriovenous malformation. Clin Case Rep. 2020;8(12):2538-2540.

Arteriovenous malformation. Brain Aneurysm Foundation.

 

Treatments will change according to the type of AVM, where it’s located, and its symptoms. Of course, physicians should also take into account the patient’s overall health. Generally, Sivakumar says, the treatment for AVM comes down to surgery. This may include surgical resection, embolization, and precisely focused radiation, which is optimal for smaller AVMs or those that are difficult to remove.

Brain avm (Arteriovenous malformation) - symptoms and causes. Mayo Clinic.

 

 

The Barrow Neurological Institute says the survival rate for an AVM rupture is 90 percent, while the morbidity rate is 25 percent—including patients who survive the initial rupture but later die due to brain damage or other complications. For patients with AVM, there’s a 2-4 percent annual hemorrhage risk.

Brain arteriovenous malformation(Avm). Barrow Neurological Institute.

 

Research shows that the “most significant predictors of mortality were a total bleeding volume greater than 9.18 cm(3), the presence of more than one symptom, and a history of previous cerebral intraparenchymal hemorrhage.”

Garcia-Espinosa P, Botello-Hernández E, Torres-Hernández G, Guerrero-Cavazos C, Villareal-Garza E, Flores-Rodriguez A. Predictors of cerebral arteriovenous malformation mortality: a single-center, five-year retrospective study. International Journal of Medical Students. 2021;9(3):213-218.

 

Physicians treating a patient with AVM need to closely monitor them for signs of hemorrhage. Imaging after treatment is also a must, Sivakumar says.