Narrative form

Arteriovenous malformation or AVM is an abnormal connection between veins and arteries,

usually congenital. Arteries and veins are part of the human cardiovascular system. Normally,
the arteries in the vascular system carry oxygen-rich blood, except in the case of the pulmonary
artery. Structurally, arteries divide and sub-divide repeatedly, eventually forming a sponge-like
capillary bed. Blood moves through the capillaries, giving up oxygen and taking up waste
products, including CO2, from the surrounding cells. Capillaries in turn successively join
together to form veins that carry blood away. The heart acts to pump blood through arteries and
uptake the venous blood.

An AVM lacks the dampening effect of capillaries on the blood flow; it also causes the
surrounding area to be deprived of the functions of the capillaries - removal of CO2 and delivery
of nutrients to the cells. The resulting tangle of blood vessels, often called a nidus (Latin for
"nest") has no capillaries and abnormally direct connections between high-pressure arteries and
low-pressure veins. It can be extremely fragile and prone to bleeding.
BRAIN

Cerebrum- The biggest part of the brain is the cerebrum. The cerebrum makes up
85% of the brain's weight, and it's easy to see why. The cerebrum is the thinking
part of the brain and it controls your voluntary muscles

Cerebellum- The cerebellum is at the back of the brain, below the cerebrum. It's a
lot smaller than the cerebrum at only 1/8 of its size. But it's a very important part of
the brain. It controls balance, movement, and coordination (how your muscles work
together).

Brain Stem- The brain stem sits beneath the cerebrum and in front of the
cerebellum. It connects the rest of the brain to the spinal cord, which runs down
your neck and back. The brain stem is in charge of all the functions your body needs
to stay alive, like breathing air, digesting food, and circulating blood.

Midbrain/ Mesencephalon- the rostral part of the brain stem, which includes the
tectum and

tegmentum. It is involved in functions such as vision, hearing, eyemovement, and

body

movement. The anterior part has the cerebral peduncle, which is a huge bundle of
axons traveling
from the cerebral cortex through the brain stem and these fibers (along with other
structures) are

important for voluntary motor function.

Pons- part of the metencephalon in the hindbrain. It is involved in motor control

and sensory

analysis... for example, information from the ear first enters the brain in the pons. It
has parts that

are important for the level of consciousness and for sleep. Some structures within
the pons are

linked to the cerebellum, thus are involved in movement and posture.

medulla oblongata is the lower portion of the brainstem. It deals with autonomic
functions, such

as breathing and blood pressure. The cardiac center is the part of the medulla
oblongata

responsible for controlling the heart rate

The cerebral circulatory system

Blood is transported through the body via a continuous system of blood vessels.Art
er ies carry oxygenated blood away from the heart intocapillar ies supplying tissue
cells.Veins collect the blood from the capillary bed and carry it back to the heart.
The main purpose of blood flow through body tissues is to deliver oxygen and
nutrients to and waste from the cells, exchange gas in the lungs, absorb nutrients
from the digestive tract, and help forming urine in the kidneys. All the circulation
besides the heart and the pulmonary circulation is called thesyst emic

circulation. Since it is the ultimate aim of this research project to image cerebral
oxygenation

and haemodynamics some aspects of the cerebral circulatory system are described
below.
Blood supply to the brain

shows an overview of the arterial system supplying the brain. The major arteries are

thever t ebr al and internal carotid arteries. The twopost er ior and single anterior
communicating

arteries form the circle of Willis, which equalises blood pressures in the brain’s
anterior and

posterior regions, and protects the brain from damage should one of the arteries
become occluded. However, there is little communication between smaller arteries
on the brain’s surface. Hence occlusion of these arteries usually results in localised
tissue damage.

Arteriovenous Malformation
Normal arteriovenous connection is depicted in the figure on top with arteries leading to
capillaries then to veins. On the bottom, an AVM is depicted with large sized shunts connecting
the artery to the vein. In this diagram three shunts are depicted. The collection of shunts is called
the nidus of the AVM. In reality, in an AVM, hundreds of shunts connect the artery to the vein.
Normal arteriovenous connection is depicted in the figure on top with arteries leading to
capillaries then to veins. On the bottom, an AVM is depicted with large sized shunts connecting
the artery to the vein. In this diagram three shunts are depicted. The collection of shunts is called
the nidus of the AVM. In reality, in an AVM, hundreds of shunts connect the artery to the vein.

http://www.aneurysm-stroke.com/av-malformation.php

http://www.scribd.com/doc/18655548/Case-Study-cerebrovascular-accident

http://www.scribd.com/doc/25243336/cva

http://www.scribd.com/doc/20844803/CVA

Pathophysiology

Blood from an intracerebral hemorrhage accumulates as a mass that can dissect through and
compress adjacent brain tissues, causing neuronal dysfunction. Large hematomas increase
intracranial pressure. Pressure from supratentorial hematomas and the accompanying edema may
cause transtentorial brain herniation, compressing the brain stem and often causing secondary
hemorrhages in the midbrain and pons (see Fig. 1: Coma and Impaired Consciousness: Brain
herniation. ). If the hemorrhage ruptures into the ventricular system (intraventricular
hemorrhage), blood may cause acute hydrocephalus. Cerebellar hematomas can expand to block
the 4th ventricle, also causing acute hydrocephalus, or they can dissect into the brain stem.
Cerebellar hematomas that are > 3 cm in diameter may cause midline shift or herniation.
Herniation, midbrain or pontine hemorrhage, intraventricular hemorrhage, acute hydrocephalus,
or dissection into the brain stem can impair consciousness and cause coma and death.