Arteriovenous Malformation (AVM)

An arteriovenous malformation (AVM) of the brain is an abnormal “tangle” of blood vessels where arteries connect directly to veins without the normal tiny vessels in between, called capillaries. Because of this shortcut, blood flows too fast and under high pressure, which can damage the vessel walls and nearby brain tissue. This can lead to headaches, seizures, or bleeding in the brain (hemorrhagic stroke). Brain AVMs are uncommon, but they are an important cause of brain bleeding in young and middle-aged adults. Mayo Clinic+2MSD Manuals+2

An arteriovenous malformation (AVM) of the brain is a knot of abnormal blood vessels where arteries connect directly to veins without the usual tiny capillaries in between. This creates a fast “short-circuit” of blood flow that puts stress on the vessel walls. Over time, the AVM can leak or bleed into the brain, cause seizures, headaches, or problems with thinking, movement, or speech. Brain AVMs are usually present from birth, but symptoms may not appear until later in life. The main long-term goal of treatment is to prevent bleeding and protect brain function. PubMed+1

Other Names for Arteriovenous Malformation of the Brain

Doctors may use different names for the same problem. These names usually describe where the AVM is or what kind of vessels are involved:

1. Brain arteriovenous malformation (brain AVM) – the everyday term.

2. Cerebral arteriovenous malformation (cerebral AVM) – “cerebral” means related to the brain. Radiopaedia+1

3. Intracranial arteriovenous malformation – “intracranial” means inside the skull.

4. Cerebral vascular malformation – a broader term also used for other vessel problems, but sometimes used for AVM. Barrow Neurological Institute+1

5. Brain vascular malformation – a general phrase that may be used in reports.

6. Pial AVM – an AVM that lies on or near the surface of the brain (the pia is the thin outer layer covering the brain). Radiopaedia

All these names point to the same main idea: an abnormal high-flow connection between arteries and veins in the brain.

Types of Brain Arteriovenous Malformations

Researchers and doctors group brain AVMs in several ways, such as how they look, where they are, or how complex they are. Radiopaedia+1

1. Classic (nidal) brain AVM
   This is the most common type. There is a central “nidus,” a knotted ball of abnormal vessels, fed by arteries and drained by veins. Blood rushes through this nidus very quickly, which increases the risk of bleeding.

2. Pial arteriovenous fistula (AVF)
   In this type, there is a more direct connection between an artery and a vein on the brain surface, sometimes without a clear nidus. Blood flow can be extremely fast, and bleeding risk may be high.

3. Micro-AVM
   These are very small AVMs, often only a few millimeters in size. They can still bleed, even though they are tiny, and sometimes are difficult to see on standard imaging tests.

4. Giant AVM
   These AVMs are very large and can involve a big part of one brain region or even more than one lobe. They are complex, may cause seizures or headaches, and can be difficult to treat because many vessels are involved. Radiopaedia+1

5. Superficial (cortical) AVM
   These AVMs lie closer to the outer surface of the brain (the cortex). They may present earlier with seizures or visible neurological symptoms and sometimes are easier to reach surgically.

6. Deep brain AVM (basal ganglia or thalamic AVM)
   These AVMs are located deep inside the brain in areas important for movement and sensation. Because of their location, they can be harder to treat and may have a higher chance of bleeding. PubMed+1

7. Infratentorial AVM (cerebellum or brainstem AVM)
   These are AVMs in the back and lower parts of the brain, such as the cerebellum or brainstem. Even small AVMs here can be dangerous, because these regions control breathing, coordination, and vital functions.

8. Periventricular AVM
   These lie near the fluid-filled spaces in the brain called ventricles. Bleeding from these AVMs can spread into the ventricles and cause sudden severe headaches and other serious symptoms.

9. Mixed vascular malformation
   Sometimes an AVM can exist together with other vascular problems, such as aneurysms (bulges in arteries) or venous malformations. This mix can change the risk of bleeding and may affect treatment decisions. PMC+1

Causes of Brain Arteriovenous Malformation

For most people, the exact cause of a brain AVM is not fully understood. Experts believe that most AVMs form before birth or soon after, when the brain’s blood vessels are still developing. Genetic and developmental factors seem to be important, and some conditions run in families. Other factors mainly make the AVM more likely to bleed or become noticeable. PubMed+2PubMed+2

1. Congenital (present from birth) vessel development error
   The most accepted cause is a mistake in how brain blood vessels form in the embryo. Instead of normal capillaries developing between arteries and veins, a shortcut forms. This error is not usually the fault of the parents and often has no clear trigger.

2. Genetic problems in vessel-building genes
   Some people have changes (mutations) in genes that control how blood vessels grow and repair. These changes can lead to fragile or abnormal vessels that connect the wrong way, making an AVM more likely. ScienceDirect+1

3. Hereditary hemorrhagic telangiectasia (HHT / Osler–Weber–Rendu syndrome)
   HHT is an inherited disorder that causes abnormal vessels in many organs, including the brain. People with HHT have a higher chance of brain AVMs and may have nosebleeds, skin spots, and lung AVMs as well.

4. Capillary malformation–AVM syndromes (for example, RASA1 or EPHB4 mutations)
   In these rare genetic disorders, people have red or pink skin marks and are prone to AVMs in the brain and other places. The gene defects interfere with normal vessel signaling and growth. ScienceDirect+1

5. Other inherited vascular malformation syndromes
   Some rare syndromes that affect vessels, such as certain phakomatoses (neurocutaneous disorders), can be linked to abnormal brain vessels, including AVMs. In these conditions, AVMs are part of a bigger pattern of brain and skin changes.

6. Family history of brain AVM
   Most AVMs are not strongly hereditary, but in a small number of families more than one person is affected. This pattern suggests that unknown genetic or shared environmental factors may play a role. PubMed+1

7. Abnormal signaling between brain cells and vessel cells
   During development, brain cells and vessel cells “talk” to each other using chemical signals. If these signals are disrupted, arteries and veins may fail to separate properly, leading to direct connections and AVM formation.

8. High-flow and high-pressure blood circuits
   Once an AVM exists, the fast blood flow through it can further damage its own vessels. This high pressure stretches the vessels, makes them thinner in places, and raises the chance of rupture and bleeding. MSD Manuals+1

9. Associated aneurysms on feeding arteries or draining veins
   Weak bulges called aneurysms may form on the arteries or veins connected to the AVM. These aneurysms are another weak point and can be a direct cause of bleeding in the brain. AHA Journals+1

10. Deep brain location and deep venous drainage (risk for bleeding)
    AVMs that lie deep in the brain and drain into deep veins have been shown to bleed more often. The exact reason is not fully clear, but the tight space and fragile deep veins may be part of the explanation. PubMed+1

11. Previous AVM hemorrhage
    If an AVM has bled once, the chance of another bleed is higher in the following years. The earlier bleed may show that the AVM anatomy is especially unstable or that its vessels are very fragile. PubMed+1

12. Uncontrolled high blood pressure
    High blood pressure does not usually create the AVM, but it can add strain to already weak abnormal vessels. This strain can be a trigger for a rupture and brain hemorrhage in someone who already has an AVM. MSD Manuals+1

13. Smoking and other lifestyle factors
    Smoking and some unhealthy habits can damage blood vessel walls and change blood clotting. While they do not directly cause an AVM, they may worsen vessel fragility and increase the risk of complications.

14. Certain drugs that sharply raise blood pressure (for example, cocaine)
    Stimulant drugs like cocaine can cause sudden spikes in blood pressure and vessel spasm. In someone with a hidden brain AVM, this sudden stress may trigger bleeding or stroke. Europe PMC+1

15. Head trauma revealing an existing AVM
    Serious head trauma is not a proven cause of AVMs, but it can uncover a previously silent AVM by causing it to bleed or by leading to brain imaging where the AVM is discovered by chance.

16. Hormonal and blood-flow changes in pregnancy
    During pregnancy, blood volume and cardiac output increase. For a person with a brain AVM, this extra flow and pressure may slightly increase the risk of bleeding, although this is still debated and rare. PubMed+1

17. Coagulation (clotting) disorders
    People with blood clotting problems or who take strong blood-thinning medicines are more likely to bleed. If they have an AVM, an otherwise small leak may turn into a larger hemorrhage.

18. Radiation or previous brain surgery in the area
    In rare cases, radiation to the brain has been linked to development of new vascular malformations years later. The exact mechanism is unclear, but radiation may damage vessel cells and repair pathways.

19. Chronic inflammation of blood vessels
    Long-lasting inflammation in vessel walls, such as in some autoimmune diseases, may weaken vessels and disturb normal healing. This might worsen the behavior of an existing AVM or make its vessels more fragile.

20. Unknown or multifactorial causes
    In many people, no clear single cause is ever found. The AVM is likely due to a mix of small genetic variations and environmental influences during early development. Current research is ongoing to understand these factors better. ScienceDirect+1

Symptoms of Brain Arteriovenous Malformation

Some people with a brain AVM have no symptoms and are diagnosed only when a scan is done for another reason. Others develop symptoms slowly over time, and some present suddenly with bleeding in the brain. How a person feels depends on the AVM’s size, location, and whether it has bled. Mayo Clinic+2Barrow Neurological Institute+2

1. Headache
   Many people with AVM have headaches. The pain may be mild and occasional or constant and severe. Sometimes a sudden, very strong “worst ever” headache can signal bleeding in the brain and is a medical emergency.

2. Seizures
   Seizures are common, especially when the AVM is near the brain surface. Seizures happen because abnormal blood flow irritates brain cells and disrupts electrical activity. They can be focal (one body part) or generalized (whole body). Barrow Neurological Institute+1

3. Weakness or paralysis of an arm or leg
   If the AVM affects areas that control movement, a person may notice weakness, clumsiness, or even paralysis of one side of the body. This can happen gradually or suddenly after a bleed.

4. Numbness or altered sensation
   Damage or pressure on sensory areas of the brain can cause numbness, tingling, or strange burning or “pins and needles” feelings, usually on one side of the body.

5. Vision problems
   AVMs near the visual pathways can cause blurred vision, loss of part of the visual field, or double vision. A person might bump into objects on one side or have trouble reading. Barrow Neurological Institute+1

6. Difficulty speaking or understanding speech
   When an AVM is in language areas of the brain, a person may have trouble finding words, forming sentences, or understanding what others say. This can be mild or very severe.

7. Problems with balance and coordination
   AVMs in the cerebellum or brainstem can cause unsteady walking, poor coordination, and difficulty doing tasks that need precise hand movements.

8. Facial weakness or drooping
   If nerves controlling facial muscles are affected, one side of the face may droop, and the mouth may pull to one side. This can look like a stroke. MSD Manuals+1

9. Dizziness or vertigo
   Some people feel lightheaded or have a spinning sensation, especially with AVMs in the back of the brain. This can be linked to balance centers or blood flow changes.

10. Confusion or memory problems
    Chronic abnormal blood flow or small bleeds around the AVM can affect thinking, attention, and memory. Family members may notice personality changes or difficulty with everyday tasks.

11. Ringing in the ears or “whooshing” sound
    In some cases, people hear a rhythmic “whoosh” in the head, called a bruit. This sound comes from fast blood flow through the AVM and is often heard more at night when it is quiet.

12. Nausea and vomiting
    These symptoms can appear with raised pressure inside the skull, especially during or after a bleed. The vomiting may be sudden and forceful.

13. Loss of consciousness or fainting
    A large bleed or sudden pressure increase can make a person collapse or become unresponsive. This is an emergency and needs immediate medical help. Mayo Clinic+1

14. Stroke-like sudden symptoms
    Sudden weakness, trouble speaking, vision loss, or severe headache can all be signs of a hemorrhage from an AVM. These symptoms are similar to other types of stroke.

15. No symptoms (incidental AVM)
    Many AVMs are found by chance when a brain scan is done for headache, trauma, or other reasons. Even without symptoms, an AVM can still have a risk of bleeding, so doctors usually investigate it carefully. professional.heart.org+1

Diagnostic Tests for Brain Arteriovenous Malformation

Doctors use several steps to diagnose a brain AVM. First, they ask detailed questions and examine the person. Then, they use blood tests, electrical tests, and brain imaging. The most important tests are imaging studies that show the blood vessels in detail. Digital subtraction angiography (DSA) is considered the gold standard for fully defining the AVM, but CT and MRI are also very important. MDPI+3PMC+3Wiley Online Library+3

Below, the tests are grouped into physical exam, manual tests, lab and pathological tests, electrodiagnostic tests, and imaging tests.

1. Medical history and general physical examination (Physical exam)
   The doctor asks about headaches, seizures, weakness, family history, and medicine use. They check blood pressure, heart rate, and general health. This basic step helps guide which further tests are needed and looks for other causes of symptoms.

2. Detailed neurological examination (Physical exam)
   The doctor checks how the brain, spinal cord, and nerves are working. They look at alertness, orientation, speech, and memory. Any abnormal findings, like one-sided weakness or language trouble, can suggest where in the brain the AVM might be. MSD Manuals+1

3. Cranial nerve examination (Manual neurological test)
   The cranial nerves control face movement, eye movements, vision, swallowing, and more. Testing these nerves can show if the AVM affects the brainstem or certain brain areas, for example if there is double vision or facial weakness.

4. Motor strength and muscle tone testing (Manual neurological test)
   The doctor asks the person to push and pull against resistance with arms and legs. They check for weakness and changes in muscle tone. Findings help locate damage in movement-control regions near or around an AVM.

5. Sensory testing (Manual neurological test)
   Light touch, pinprick, vibration, and temperature are tested on the skin. If the person cannot feel normally on one side, the doctor may suspect involvement of sensory pathways close to an AVM.

6. Reflex testing, including Babinski sign (Manual neurological test)
   The doctor taps tendons with a hammer to check reflexes in arms and legs, and may scratch the sole of the foot to test the Babinski sign. Very brisk or absent reflexes can point to damage in the motor pathways linked to an AVM.

7. Coordination and cerebellar testing (Manual neurological test)
   The person is asked to touch their nose and then the doctor’s finger, or to slide a heel along the opposite shin. Poor coordination can suggest an AVM in the cerebellum or its connections.

8. Gait and balance assessment (Manual neurological test)
   The doctor watches the person walk and may ask them to walk heel-to-toe or stand with feet together and eyes closed. Problems with balance or a wide-based, unsteady gait can indicate involvement of balance centers or long tracts affected by an AVM. MSD Manuals+1

9. Complete blood count (CBC) (Lab test)
   A CBC measures red cells, white cells, and platelets. It can show anemia from previous bleeding or low platelets that increase bleeding risk. Although it does not detect an AVM directly, it helps assess overall safety for surgery or other procedures.

10. Coagulation profile (PT, INR, aPTT) (Lab test)
    These tests measure how well the blood clots. Abnormal results, or use of blood-thinning drugs, mean a higher risk of bleeding from an AVM or during treatment. Doctors may correct these problems before surgery or invasive tests. PubMed+1

11. Serum electrolytes and metabolic panel (Lab test)
    These blood tests check sodium, potassium, kidney function, and liver function. Abnormal values can worsen seizures, brain swelling, or response to medications. They are important for safe management but do not diagnose the AVM itself.

12. Genetic testing for hereditary hemorrhagic telangiectasia and related syndromes (Lab / genetic test)
    If a person has nosebleeds, skin spots, or a family history suggesting HHT or other vascular syndromes, genetic tests may be done. Finding a mutation can explain why the AVM formed and guide screening for other AVMs in the body. ScienceDirect+1

13. Electroencephalogram (EEG) (Electrodiagnostic test)
    EEG records the brain’s electrical activity using small electrodes on the scalp. In people with AVM-related seizures, EEG can show abnormal spikes or waves in the area near the AVM. This helps confirm that seizures are truly coming from the brain and may help plan surgery. PMC+1

14. Evoked potential studies (Electrodiagnostic test)
    In these tests, the brain’s response to visual or sensory signals is recorded. They can show if pathways for vision or touch are slowed or damaged by an AVM or its treatment. They are sometimes used before or during surgery to protect important networks.

15. Non-contrast CT scan of the brain (Imaging test)
    A simple CT scan is often the first brain imaging test in emergencies. It can quickly show bleeding, brain swelling, or calcifications related to an AVM. CT is widely available and works fast, which is crucial in acute situations. AJNS+1

16. CT angiography (CTA) (Imaging test)
    CTA combines CT with contrast dye injected into a vein. It outlines arteries and veins and can show the AVM’s nidus, feeding arteries, and draining veins. CTA is very helpful for initial mapping but may miss very small or very complex details compared with catheter angiography. www.elsevier.com+1

17. MRI of the brain (Imaging test)
    MRI uses strong magnets and radio waves to produce detailed images of brain tissue. It can show the AVM, old and new bleeds, and damage to nearby brain areas. MRI is especially useful in people with seizures or chronic symptoms. eMedicine+1

18. MR angiography (MRA) (Imaging test)
    MRA is a special MRI method that focuses on blood vessels. It helps show the AVM’s vessels without needing catheter angiography in some cases. MRA is non-invasive, but its detail is still usually less than DSA. Brieflands+1

19. Digital subtraction cerebral angiography (DSA) (Imaging test – gold standard)
    In DSA, a catheter is threaded through an artery (often from the groin) up into the brain arteries, and contrast dye is injected while X-ray pictures are taken. This test gives very detailed images of the AVM, including feeding arteries, the nidus, draining veins, and associated aneurysms. It is considered the gold standard for diagnosis and treatment planning. PMC+2Wiley Online Library+2

20. Transcranial Doppler ultrasound (Imaging / hemodynamic test)
    This test uses sound waves placed on the skull to measure blood flow speed in major brain arteries. In some centers, it is used to study blood flow changes in people with vascular malformations, including AVMs, and to monitor circulation before and after treatment.

These tests, used together, allow doctors to confirm the presence of a brain AVM, understand its size and structure, and plan the safest and most effective treatment based on current guidelines from expert groups such as the American Heart Association and the American Stroke Association. AHA Journals+2PubMed+2

Non-pharmacological treatments

1. Careful observation and monitoring
Sometimes the safest option is “watchful waiting,” especially for small AVMs in risky brain areas. The neurologist or neurosurgeon follows you with regular visits and scans (MRI or CT) to see if anything changes. The purpose is to avoid the risks of surgery while still keeping a close eye on the AVM, your blood pressure, and any new symptoms like headaches or seizures. PubMed+1

2. Blood pressure control through lifestyle
High blood pressure can increase the chance of bleeding from a brain AVM. Non-drug steps include reducing salt in food, staying at a healthy weight, gentle regular exercise (like walking), and avoiding energy drinks or other stimulants. These habits help lower pressure inside blood vessels and reduce stress on the AVM over time, working together with any medicines your doctor may prescribe. PubMed

3. Smoking and vaping cessation
Smoking and nicotine damage blood vessels and raise blood pressure. For someone with a brain AVM, this can make bleeding more likely over many years. Stopping smoking or vaping lets blood vessels work better and improves oxygen delivery to the brain. Counseling, support groups, and nicotine-free strategies can make quitting easier and safer. PubMed

4. Limiting alcohol and avoiding illegal drugs
Heavy drinking and drugs like cocaine or amphetamines can sharply raise blood pressure and disturb blood flow in the brain, which is dangerous when you have an AVM. Cutting alcohol to low or moderate levels and staying away from street drugs lowers sudden pressure spikes. This reduces the risk of hemorrhage and also improves sleep, mood, and overall brain health. PubMed

5. Activity and lifting modifications
Your care team may advise avoiding very heavy lifting, extreme straining, or intense power sports that sharply raise blood pressure inside the head. Instead, they usually encourage light to moderate aerobic exercise such as walking, cycling, or swimming. The purpose is to stay fit without causing big blood pressure peaks that could stress fragile AVM vessels. PubMed

6. Seizure safety and lifestyle planning
If you have seizures from a brain AVM, non-drug measures include regular sleep, avoiding flashing lights if they trigger seizures, showering instead of taking unsupervised baths, and following local driving rules for people with epilepsy. These steps do not stop seizures by themselves, but they reduce harm if a seizure happens and support the effect of anti-seizure medicines. PubMed

7. Headache management without medicines
Some people with AVMs have chronic headaches. Non-drug options include keeping a headache diary, learning relaxation breathing, using cold or warm packs on the neck, neck-stretching exercises, and good sleep hygiene. These methods aim to reduce muscle tension, stress, and poor sleep, which all make headaches worse, and can reduce the amount of pain medicine needed. PubMed

8. Psychological support and counseling
Living with a brain AVM can cause anxiety, fear of bleeding, and low mood. Talking therapies, such as cognitive-behavioral therapy (CBT) or supportive counseling, can help you handle worry and adjust to lifestyle limits. The goal is to strengthen emotional coping skills, reduce stress hormones, and improve daily quality of life, which indirectly supports brain health and recovery. PubMed

9. Physical therapy (after bleeding or surgery)
If the AVM has bled or has been treated surgically, physical therapy focuses on regaining strength, balance, and coordination. Therapists design safe exercises to retrain weak muscles and improve walking. Over time, this helps the brain build new pathways around injured areas, making daily activities like standing, walking, and climbing stairs more independent again. PMC+1

10. Occupational therapy
Occupational therapists help you relearn everyday tasks such as dressing, cooking, or using a computer after a brain injury. They may suggest tools like special handles or home changes like grab bars. The purpose is to make your home and routine safer and easier, so you can return to school, work, or hobbies as independently as possible. PubMed

11. Speech and language therapy
If the AVM affects areas for speech or understanding language, a speech therapist can help you practice sounds, words, and safe swallowing. Therapy is repeated, structured practice that encourages the brain to form new connections. Over time, this can improve speech clarity, understanding, and ability to eat and drink safely. PubMed

12. Cognitive rehabilitation
Some people with brain AVMs have trouble with memory, attention, or planning. Cognitive rehab uses exercises, computer tasks, and strategy training to improve these skills. The aim is to help you manage schoolwork, jobs, and daily planning using both brain training and practical tools like planners and phone reminders. PubMed

13. Balance and vestibular therapy
If the AVM or its treatment affects balance centers, therapists can teach eye, head, and body exercises that slowly retrain your balance system. You practice standing, walking, and turning in graded steps. This helps reduce dizziness, lowers fall risk, and makes moving around more confident and safe. PubMed

14. Fall-prevention and home safety changes
Simple changes like removing loose rugs, using handrails on stairs, and good lighting lower the chance of falls, especially if you have weakness or balance problems. Avoiding head injuries is very important when you have an AVM or a recent brain bleed. Safety planning protects both the AVM and the healing brain tissue. PubMed

15. Patient and family education
Education sessions help you and your family understand what a brain AVM is, what symptoms to watch for, and how treatments work. When everyone shares a clear plan, it is easier to respond quickly if new headaches, weakness, or seizures appear. Knowledge reduces fear and helps families support safer choices at home and school. PubMed+1

16. Support groups and peer networks
Meeting others who live with AVMs or have survived brain hemorrhage can make you feel less alone. Support groups (in person or online) allow people to share tips and emotions. This social connection can reduce anxiety and depression, which indirectly helps with recovery and sticking to treatment. PubMed

17. School or work accommodations
If concentration, fatigue, or seizures affect performance, teachers or employers can offer extra time, quiet spaces, or modified workloads. These adjustments lower stress and make it more realistic to keep up with responsibilities. The aim is to maintain education and employment while respecting medical limits. PubMed

18. Pregnancy and family-planning counseling
Pregnancy can change blood volume and pressure, which may affect bleeding risk in people with an AVM. Specialists can discuss timing of pregnancy, monitoring plans, delivery options, and genetic counseling if a hereditary condition is suspected. The goal is to plan safely and reduce complications for both parent and baby. PubMed

19. Emergency action plan for stroke-like symptoms
Your team may give you and your family clear instructions: which emergency number to call, which hospital to go to, and what symptoms mean “go now” (sudden severe headache, weakness, trouble speaking). Practicing this plan saves time if a bleed happens and can improve survival and recovery chances. PubMed+1

20. Careful review of other medicines and supplements
Some drugs (like blood thinners or strong anti-inflammatory painkillers) can increase bleeding risk. Doctors review all your prescriptions, over-the-counter medicines, and supplements to check for interactions and bleeding risk. The purpose is to keep necessary treatments but remove or adjust any that might make an AVM bleed more likely. Never change medicines on your own. PubMed

Drug treatments

Medicines do not remove the AVM itself. They mainly control seizures, pain, blood pressure, and brain swelling. All doses below are typical adult ranges and must be adjusted only by a doctor.

1. Levetiracetam (Keppra) – anti-seizure drug
Levetiracetam is a common first-line medicine for seizures caused by brain AVMs. It is usually started around 500 mg twice daily and can be increased up to about 3000 mg per day depending on response and kidney function. It works by stabilizing brain electrical activity. Common side effects include sleepiness, dizziness, and mood changes. FDA Access Data+2FDA Access Data+2

2. Lacosamide (Vimpat) – anti-seizure add-on
Lacosamide is used when seizures remain active despite other drugs. It often starts at 50 mg twice daily and is slowly increased. It helps control seizures by enhancing slow inactivation of sodium channels in brain cells. Possible side effects include dizziness, nausea, and changes in heart rhythm, so ECG monitoring may be needed in some people. FDA Access Data+2FDA Access Data+2

3. Valproic acid / Divalproex – broad-spectrum anti-seizure
Valproate treats many seizure types and can be useful if the AVM causes mixed seizure patterns. Doses are usually based on body weight and blood levels. It increases brain GABA (a calming chemical). Important side effects include liver problems, weight gain, tremor, and birth-defect risk if taken during pregnancy, so it must be used carefully, especially in people who could become pregnant. PubMed

4. Lamotrigine – anti-seizure and mood stabilizer
Lamotrigine can help with focal seizures from AVMs and may also stabilize mood. The dose is increased very slowly over weeks to reduce the risk of serious rash. It works by blocking certain sodium channels and reducing glutamate release. Common side effects are dizziness, headache, and mild rash; any severe rash requires urgent medical review. PubMed

5. Carbamazepine – focal seizure controller
Carbamazepine is useful if the AVM irritates one part of the brain and causes focal seizures. It is usually taken two or three times a day, with dosing guided by blood levels. It stabilizes brain cell membranes and reduces repeat firing. Side effects include dizziness, low sodium, and rare blood count changes, so blood tests are often needed. PubMed

6. Phenytoin / Fosphenytoin – emergency seizure control
In emergencies such as repeated seizures after an AVM bleed, phenytoin or its IV form, fosphenytoin, may be used. Hospitals give weight-based loading doses followed by maintenance doses. These drugs stabilize sodium channels in neurons. Side effects can include low blood pressure, heart rhythm changes (with IV use), gum swelling, and long-term bone thinning. PubMed

7. Benzodiazepines (e.g., lorazepam, diazepam) – rescue medicines
These medicines are used for short-term seizure stopping, especially in the emergency room or as rescue at home. They boost GABA activity to quickly calm over-active brain cells. Side effects include drowsiness, breathing slowing at high doses, and dependence if taken regularly, so they are usually reserved for brief rescue use, not daily long-term control. PubMed

8. Nimodipine – calcium-channel blocker for vasospasm (SAH)
Nimodipine is a calcium-channel blocker used mainly after subarachnoid hemorrhage to reduce the risk of delayed brain ischemia from blood vessel spasm. It is taken by mouth several times a day. It works by relaxing brain arteries. Side effects include low blood pressure and flushing, so monitoring is important. FDA Access Data+2FDA Access Data+2

9. Nicardipine (IV) – blood pressure control in ICU
Nicardipine is an IV calcium-channel blocker commonly used in intensive care to gently lower blood pressure after brain hemorrhage. It acts by relaxing artery walls and is given as a continuous infusion that nurses adjust. Side effects include low blood pressure and fast heart rate, so heart and pressure are closely watched during treatment. PubMed

10. Labetalol – beta-blocker for blood pressure
Labetalol blocks certain adrenaline receptors, lowering blood pressure and heart rate. It can be given by mouth for long-term control or by IV in emergencies. Lowering blood pressure reduces strain on fragile AVM vessels. Side effects include tiredness, dizziness, and possible worsening of asthma, so it must be chosen carefully based on a person’s history. PubMed

11. Hydralazine – blood vessel relaxer
Hydralazine relaxes smooth muscle in arterial walls, helping lower blood pressure when quick control is needed. It is used in some brain hemorrhage protocols. It is usually given orally or by IV in a hospital. Side effects include headache, fast heart rate, and fluid retention, so it is often combined with other blood pressure medicines. PubMed

12. Mannitol – osmotic agent for brain swelling
Mannitol is a sugar alcohol given through a vein to pull extra water out of swollen brain tissue into the bloodstream, lowering pressure inside the skull. It is used in emergencies after AVM rupture or surgery. Side effects include dehydration, changes in sodium levels, and kidney strain, so blood work and urine output are monitored carefully. PubMed

13. Hypertonic saline – alternative for raised intracranial pressure
Hypertonic saline is a very salty IV fluid that also pulls fluid out of the brain to lower swelling. It may be used instead of or in addition to mannitol in the ICU. Doctors carefully track blood sodium and brain pressure. Side effects include overly high sodium, fluid overload, or heart strain if not closely monitored. PubMed

14. Acetaminophen (paracetamol) – pain and fever relief
Acetaminophen is often used for headaches or fever after AVM diagnosis or treatment because it does not thin the blood like some NSAIDs. Usual adult doses are up to 3000–4000 mg per day, but the exact safe limit depends on liver health. The main risk is liver damage if the dose is too high or mixed with a lot of alcohol. PubMed

15. Stool softeners (e.g., docusate, polyethylene glycol)
After brain surgery or hemorrhage, avoiding strong straining on the toilet is important because it spikes blood pressure. Stool softeners make bowel movements easier and reduce this strain. They are usually taken once or twice daily with plenty of water. Side effects are usually mild and mostly involve bloating or loose stools if the dose is high. PubMed

16. Anti-nausea drugs (e.g., ondansetron)
Nausea and vomiting often follow brain surgery or high intracranial pressure. Ondansetron and similar drugs block serotonin receptors that trigger vomiting. They are given by mouth or IV. Controlling vomiting reduces sudden pressure rises in the brain and makes recovery more comfortable. Side effects can include constipation and, rarely, heart rhythm changes. PubMed

17. Proton pump inhibitors (e.g., omeprazole)
In intensive care, stress and certain medicines can irritate the stomach and cause bleeding. Proton pump inhibitors reduce stomach acid to protect the lining. They are taken once or twice a day. Side effects include headache and rare vitamin or mineral absorption problems with long-term use. They are usually used for limited periods in hospital care. PubMed

18. Short-term anti-anxiety medicines
Some patients with AVMs have severe anxiety that worsens headaches and blood pressure. Doctors may use short courses of anti-anxiety medicines or certain antidepressants alongside counseling. These act on serotonin, noradrenaline, or GABA systems in the brain to balance mood. Because of side-effect and dependence risks, they are carefully chosen and monitored. PubMed

19. Long-term blood pressure tablets (ACE inhibitors, ARBs, others)
Drugs like enalapril (an ACE inhibitor) or losartan (an ARB) may be used for long-term blood pressure control. They relax blood vessels and help the heart pump against lower resistance. Side effects can include cough (ACE inhibitors), kidney changes, or high potassium, so regular blood tests are needed. Keeping blood pressure controlled lowers bleeding risk from AVMs. PubMed

20. Pain-relief “rescue” medicines under supervision
If severe headaches continue despite basic measures, doctors may use stronger pain medicines for short periods. These must be used very carefully to avoid dependence and to make sure they do not raise pressure in the head. The aim is to keep pain controlled enough so that the person can rest, sleep, and participate in therapy. PubMed

Dietary molecular supplements

Supplements cannot shrink or cure an AVM. Always ask your doctor before starting any, especially if you take seizure or blood pressure medicines.

1. Omega-3 fatty acids (fish oil)
Omega-3 fats (EPA and DHA) may support heart and blood-vessel health and reduce inflammation. Typical doses in studies range around 1000–2000 mg of combined EPA/DHA daily, taken with food. They may slightly thin the blood, so your doctor must check if they are safe for you, especially after a brain bleed. PubMed

2. Vitamin D3
Vitamin D helps bone and immune health and may support brain function. Many adults take around 800–2000 IU daily, but the dose should be guided by blood levels. In people who are low in vitamin D, correcting the deficiency can improve muscle strength and overall health, which helps with rehab after brain injury. PubMed

3. Vitamin B12
Vitamin B12 is important for nerves and blood cells. If levels are low, doctors may use tablets or injections to bring them back to normal. Doses vary widely, from 250–1000 mcg daily by mouth to larger doses by injection. Correcting B12 deficiency can support thinking, balance, and nerve repair over time. PubMed

4. Folate (folic acid)
Folate is another B vitamin that supports cell growth and helps control homocysteine, a chemical linked to blood-vessel health. Typical supplement doses are 400–800 mcg daily unless higher doses are prescribed. In people who are deficient, folate correction supports red blood cell production and may support vascular health along with other treatments. PubMed

5. Magnesium
Magnesium helps nerves and muscles function properly and plays a role in blood pressure control. Supplements might range from 200–400 mg elemental magnesium per day, depending on kidney function. Side effects can include diarrhea at higher doses. Adequate magnesium may support relaxation and reduce muscle cramps and headaches in some people. PubMed

6. Coenzyme Q10 (CoQ10)
CoQ10 is involved in energy production in mitochondria. Supplements of about 100–200 mg per day have been studied in heart and neurological conditions. It may support energy levels and antioxidant protection in brain cells under stress, though evidence in AVM is indirect. It can sometimes cause stomach upset, so taking it with food often helps. PubMed

7. Curcumin (from turmeric)
Curcumin is a plant compound with anti-inflammatory and antioxidant properties. Doses in supplements often range from 500–1000 mg per day, frequently combined with black pepper extract for better absorption. It may help reduce systemic inflammation, but high doses can irritate the stomach or interact with blood thinners, so medical advice is essential. PubMed

8. Resveratrol
Resveratrol, found in grapes and berries, has antioxidant effects and may benefit blood vessels in some studies. Supplements are usually 100–500 mg daily. It is not a treatment for AVM, but in correct patients it might support general vascular health. Possible side effects include stomach upset and interactions with other medicines that affect clotting. PubMed

9. Vitamin C
Vitamin C supports blood-vessel walls, immune function, and healing. Many people take 200–500 mg per day from food and supplements combined. When deficiency is corrected, bruising and poor wound healing can improve. Very high doses can cause stomach upset or kidney stones in some people, so more is not always better. PubMed

10. Vitamin E
Vitamin E is a fat-soluble antioxidant that protects cell membranes. Low-to-moderate doses (often 100–200 IU daily) may help general vascular health, but high doses can increase bleeding risk. Because people with AVMs already worry about bleeding, any vitamin E supplement should be discussed with a specialist first. PubMed

Immune-supporting and regenerative / stem-cell-related drugs

Right now, there are no standard “stem cell drugs” or immune-boosting medicines approved specifically to treat brain AVMs. The options below are mostly research ideas used only in clinical trials or special situations.

1. Vaccinations (e.g., flu, pneumonia vaccines)
Routine vaccines do not treat AVMs but help the immune system prevent serious infections that could stress the body, raise blood pressure, or lead to hospital stays. Doses follow standard schedules based on age and risk. The main idea is to keep you generally healthy so that surgery, radiosurgery, or recovery from hemorrhage is safer. PubMed

2. Erythropoietin (EPO – neuroprotective research)
Erythropoietin is mainly used for certain anemias, but has been studied in some brain injury and stroke trials for possible nerve protection. Research doses are carefully defined within trials, not self-prescribed. EPO acts on receptors in the brain and blood vessels, but it can also raise blood pressure and clot risk, so it is not routine for AVMs. PubMed

3. Granulocyte colony-stimulating factor (G-CSF)
G-CSF boosts production of white blood cells and has been explored as a way to mobilize stem cells and support brain repair in some studies. Doses are injected under the skin and are set by trial protocols. Side effects can include bone pain and high white-cell counts. Its use in AVM is experimental only. PubMed

4. Mesenchymal stem cell therapy (research only)
Mesenchymal stem cells, taken from bone marrow or fat, are being tested in a few neurological conditions to see if they can reduce inflammation and promote repair. Doses, delivery routes, and schedules are strictly controlled in studies and not standard care. For AVMs, this approach is still in early investigation, and long-term safety is not fully known. ScienceDirect

5. Neural stem cell transplantation (research only)
Neural stem cells aim to replace or support damaged brain cells. In experimental settings, they may be injected into or near injured areas of the brain. There is no approved protocol for AVMs, and potential risks include immune reactions and abnormal cell growth. This remains a scientific research field, not a usual treatment. ScienceDirect

6. Autologous bone-marrow–derived cell infusions (research)
Some trials explore using a patient’s own bone marrow cells to support recovery after stroke or brain injury. Cells are collected, processed, and infused back into the bloodstream. The idea is that they may release helpful growth factors. For AVMs, such approaches are still experimental, with no confirmed benefit and possible unknown risks. ScienceDirect

Surgeries and procedures

1. Microsurgical resection of the AVM
In this operation, a neurosurgeon opens the skull and carefully separates and removes the AVM from normal brain tissue. The goal is complete removal of the abnormal vessels so no fragile channels remain to bleed. This is often used for small or medium AVMs in areas where surgeons can safely reach them, especially after a hemorrhage. PubMed+1

2. Endovascular embolization
In embolization, a doctor threads a small catheter through blood vessels (often from the groin) up to the AVM and injects tiny particles, glue, or coils to block abnormal flow. Sometimes embolization is used alone for small AVMs, but more often it is used before surgery or radiosurgery to shrink the AVM and reduce bleeding risk during the main treatment. PMC+1

3. Stereotactic radiosurgery (SRS)
SRS is a focused radiation treatment (such as Gamma Knife) that delivers precise high-dose beams to the AVM without opening the skull. Over 1–3 years, radiation damages the inner lining of the AVM vessels, causing them to thicken and eventually close. This method is especially useful for deep or medium-sized AVMs that are too risky for open surgery. MDPI+2PubMed+2

4. Combined or staged treatments
Many patients get a combination of treatments, such as embolization first to reduce flow, followed by surgery to remove the rest, or embolization plus SRS. This staged approach tries to balance safety and effectiveness for larger or more complex AVMs. Decisions are made by a multidisciplinary team including neurosurgeons, interventional neuroradiologists, and radiation specialists. PMC+2PubMed+2

5. Emergency surgery for hemorrhage (hematoma evacuation / decompressive craniectomy)
If an AVM suddenly bleeds and causes dangerous brain swelling, emergency surgery may be needed to remove the blood clot and sometimes part of the skull to relieve pressure. In some cases, the surgeon will also treat the AVM itself. The goal is to save life, protect brain tissue, and stabilize the patient for later, more planned treatment. PubMed+1

Prevention tips

1. Keep blood pressure in a healthy range with lifestyle and prescribed medicines. PubMed

2. Do not smoke or vape; if you do, ask for help to stop. PubMed

3. Avoid cocaine, amphetamines, or other stimulants that can spike blood pressure. PubMed

4. Limit alcohol to low or moderate amounts, and avoid binge drinking. PubMed

5. Stay active with gentle to moderate exercise approved by your doctor. PubMed

6. Avoid blood thinners or strong NSAIDs unless a specialist clearly recommends them. PubMed

7. Manage other vascular risks like diabetes, high cholesterol, and obesity. PubMed

8. Use helmets and seatbelts to reduce the chance of head injury. PubMed

9. Attend all follow-up visits and imaging to check the AVM or monitor after treatment. AHA Journals

10. If there is a family history of AVMs or related syndromes, ask about genetic counseling. PubMed

When to see a doctor urgently

You should seek urgent or emergency medical care if you notice sudden, very severe headache (“worst headache of your life”), new weakness or numbness on one side of the body, trouble speaking or understanding words, loss of vision, seizures that are new or different, sudden confusion, or trouble walking and balancing. These can be signs of bleeding from an AVM or another stroke. After any known AVM diagnosis or treatment, your team should also give you specific warning signs and emergency numbers. PubMed+1

For routine care, see your neurologist or neurosurgeon if you have more frequent headaches, small changes in memory, mood or school performance, or any side effects from medicines like extreme tiredness, rash, or mood changes.

What to eat and what to avoid

1. Eat: plenty of fruits and vegetables every day for vitamins and antioxidants that support blood-vessel health. PubMed

2. Eat: whole grains like oats, brown rice, and whole-wheat bread to help control weight and blood pressure. PubMed

3. Eat: lean protein such as fish, beans, lentils, and skinless chicken to support healing and muscles for rehab. PubMed

4. Eat: small amounts of healthy fats (olive oil, nuts, seeds) instead of deep-fried foods to protect heart and vessels. PubMed

5. Eat: enough water through the day unless your doctor sets a fluid limit, to help circulation and prevent constipation. PubMed

6. Avoid: very salty foods like instant noodles, salty chips, and pickles, which increase blood pressure. PubMed

7. Avoid: large amounts of sugar-sweetened drinks and sweets that add weight and strain the heart and vessels. PubMed

8. Avoid: heavy, fatty fast food and processed meats, which raise cholesterol and long-term vascular risk. PubMed

9. Avoid: energy drinks and high-caffeine products that can suddenly raise blood pressure and heart rate. PubMed

10. Avoid: herbal or “natural” supplements that claim to thin the blood or “boost circulation” unless your doctor approves them, because they might increase bleeding risk. PubMed

Frequently asked questions

1. Can a brain AVM go away by itself?
Most brain AVMs do not disappear on their own. Very rarely, some may shrink or close after a bleed or other changes in blood flow, but this is unusual. In most cases, the AVM remains until it is treated with surgery, embolization, radiosurgery, or a combination of treatments. PubMed+1

2. Is every AVM dangerous?
All AVMs have some risk of bleeding, but the amount of risk depends on size, location, whether they have bled before, and the patterns of blood flow and veins. Some very small, deep AVMs may be safer to observe than to operate on, while others are better treated quickly. PubMed+1

3. How do doctors decide the best treatment?
A team usually reviews your age, symptoms, AVM size and location, imaging findings, and overall health. They compare the natural risk of leaving the AVM alone with the risks of surgery, embolization, or radiosurgery. Sometimes they recommend a combination or even careful observation if treatment risks are too high. PubMed+1

4. Does treatment always cure the AVM?
Surgery and radiosurgery aim for complete “obliteration,” meaning no abnormal vessels are left. This is checked with special imaging such as angiography. Some AVMs close fully after treatment, while others only partly shrink and may need additional stages or a different method to finish the job. PMC+2MDPI+2

5. Can I live a normal life with a brain AVM?
Many people with AVMs, especially those that have been fully treated, live active, independent lives. You might need to follow some limits on extreme sports, heavy lifting, or driving if you have seizures. Regular follow-up and healthy lifestyle choices improve your chances of a stable, normal life. PubMed+1

6. Do I have to take seizure medicine forever?
Not always. If you have seizures, anti-seizure medicines are usually needed for at least several years and sometimes longer. If the AVM is completely removed and you stay seizure-free for a long time, your neurologist may slowly try to reduce or stop the medicine. This must always be done under close medical supervision. PubMed

7. Is radiosurgery safer than open surgery?
Radiosurgery avoids opening the skull, so the immediate surgical risk is often lower, especially for deep or hard-to-reach AVMs. However, it takes time (months to years) for the AVM to close, and bleeding risk continues during that period. Open surgery has higher short-term risk but, when successful, removes the AVM immediately. MDPI+2PubMed+2

8. Can an AVM come back after it is removed?
If imaging confirms complete removal or obliteration, recurrence is rare in adults but can occasionally happen, especially in children. Regular follow-up scans are more important in younger patients or if there are hereditary conditions. Any new symptoms should always be checked. PubMed+1

9. Are there medicines that shrink or dissolve AVMs?
Right now, there are no standard medicines that reliably shrink or dissolve brain AVMs. Drugs mainly control symptoms like seizures, pain, and blood pressure or help manage complications after bleeding or surgery. Definitive treatment relies on surgery, embolization, or radiosurgery. PubMed+1

10. Is pregnancy safe with a brain AVM?
Many people with AVMs have safe pregnancies, but careful planning is important. Blood volume and pressure change during pregnancy and birth, which may affect bleeding risk. An obstetrician, neurologist, and neurosurgeon should plan together, and sometimes treatment is done before pregnancy to reduce risk. PubMed+1

11. What is the risk if my AVM has already bled once?
An AVM that has bled before usually has a higher chance of bleeding again, especially in the first few years after the first hemorrhage. Because of this, doctors often recommend more active treatment for previously ruptured AVMs if it can be done safely. PubMed+1

12. Does diet really matter for AVMs?
Diet does not directly change the structure of an AVM, but it strongly affects blood pressure, weight, and overall vessel health. A heart-healthy, low-salt diet supports any other treatment you receive and lowers your risk of other vascular problems like stroke or heart disease. PubMed

13. What happens if I ignore my AVM?
Some AVMs may stay stable for years, but others can bleed without warning and cause serious brain injury or even death. Ignoring the condition means missing the chance to discuss safer plans and monitoring. It is always better to talk regularly with specialists and decide together what level of treatment or observation is right for you. PubMed+1

14. Can children and teenagers get brain AVMs?
Yes. Brain AVMs are often present from birth, so they can be found in children or teenagers, sometimes after seizures, headaches, or a bleed. Because children have many years ahead, doctors are especially careful about long-term risk and often consider definitive treatment if it is safe. PubMed+1

15. Who should I see for care of a brain AVM?
Care is best provided by a team in a center that regularly treats brain AVMs. This usually includes a neurologist, neurosurgeon, interventional neuroradiologist, radiation oncologist, and rehab specialists. Working with an experienced team improves decision-making and outcomes, because they understand the complex balance between treatment risks and benefits. PubMed+1

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: December 21, 2025.

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