Thursday, December 14, 2006

Senator Tim Johnson's AVM Hemmorrhage

"In fact, only one third of those who experience aneurysmal subarachnoid hemorrhages recover without major disability." This speaks of an aneurysm which is a blood vessel rupture and an AVM is a malformed Artery-Venous conjunction without capilliaries bridging this transition. Both however they are both subachnoid bleeds.
  • by Deidre Buckley, RN, NP
    coordinator of the MGH Brain Aneurysm-AVM Center
  • It is estimated that more than two million people in the United States are living with un-ruptured intracerebral aneurysms. When an aneurysm ruptures, it usually causes bleeding into the subarachnoid space (the compartment surrounding the brain), and it can be fatal.
  • In this country alone, there are approximately 30,000 new cases each year of subarachnoid hemorrhages due to the rupture of intra-cranial aneurysms. They accounts for 6-8% of all strokes, and continue to be a significant cause of morbidity and mortality.
  • Despite numerous diagnostic, surgical, anesthetic and peri-operative advances, outcomes for patients with ruptured aneurysms remain poor. In fact, only one third of those who experience aneurysmal subarachnoid hemorrhages recover without major disability. Cerebral aneurysm rupture is most prevalent in the 35-60 year-old age group, with 50 being the mean age of occurrence.
  • Though advanced imaging technology allows non-invasive detection of aneurysms or AVMs (atrioventricular malformations), most aneurysms are not detected until after rupture. People typically experience the ‘worst headache’ of their life and then seek medical attention (if they survive the event).
  • The recovery process following aneurysm treatment is long, especially after a hemorrhage, and can be unsettling, especially if you’re not prepared.
  • On August 22, 23, and 24, 2001, from 9:00am –3:00pm, representatives from the Brain Aneurysm Foundation will staff an information booth in the Central Lobby. Staff will be on hand to answer questions and written materials will be available. On August 23, a symposium, "Bridging the gap between clinicians, patients and their families," will be held under the Bullfinch tent from 6:00–9:00pm; Sucheta Kamath, MA, CCC/SLP, president of the Brain Aneurysm Foundation, will speak about the Steps to Success Program, and there will be other speakers as well. All are welcome to attend. For more information, call 723-3870.
Here is a Primer on AVM:
From Brain-Surgery: AVM s can occur in any area of the brain, and may be either small or large. When they hemorrhage, they usually do so with a limited amount of blood, unlike the hypertensive hemorrhages of other stroke patients. Loss of neurologic function depends on both the location of the AVM and the amount of bleeding. Many patients have very small hemorrhages, often multiple. They may display convulsions before even knowing about the presence of an AVM. Some patients suffer with headaches, often unrelated to the AVM which are usually found with a CT scan or brain MRI. In rare instances, children are born with large AVM's and are found to have heart failure because the malformation makes the heart work beyond its capacity.
These lesions are surrounded by a very discrete layer of abnormal, nonfunctioning brain tissue, thus allowing their removal with relative safety to the surrounding brain. This factor is of the utmost importance to the brain surgeon, who can take advantage of this natural separation between normal brain tissue and the abnormal vascular malformation

Avenous malformations are masses of abnormal blood vessels which grow in the brain. They consist of a blood vessel "nidus" (nest) through which arteries connect directly to veins, instead of through the elaborate collection of very small vessels called capillaries. Some people are born with the nidus, but as the years go by, it tends to enlarge as the great pressure of the arterial vessels can not be handled by the veins that drain out of it. This causes a large collection of worm-like vessels to develop (malform) into a mass capable of bleeding at some future time. These malformations are most likely to bleed between the ages of 10 - 55; after 55, the chances of bleeding diminishes rapidly. Before 55, the likelihood of hemorrhaging is betweeen 3 and 4% per year (with a death incidence of about 1%). Once an AVM patient has hemorrhaged, the risk of having another one might approach 20% during the first year, and gradually lessen to about 3 - 4% over the NEXT YEARS..
avm illustration,very simple
© 1987, Barrow Neurological Institute.  With permission. special radiol.graph
There as been much talk about Senator Tim Johnson's condition and issues regarding his seat. As you know he had an AVM rupture. Arterovenous Malformation rupture. This is a congenital vascular anomaly which is nothing more than a redundant vascular tangle of small arteries(arterioles), with the bridging capillaries leading over to the small veins(venules). Often times this web of vessels ruptures or leak. The Port Wine birth marks Gorbachev had are a smilar type phenomenon however with capillaries and they can occur on the skin as in the brain because skin and nervous tissue form from the embryonic ectoderm. If Gorby ever nicked himself with the hair clippers before he went bald he would have bleed like a sieve.
I have treated many many patients with the AVM malformation Intracranial Hemorrhagic accident. The sooner these folks wake up from surgery and start to function cognitively and neurologically the better their prognosis is. Of course it all depends on the amount of bleeding took place which can damage the brain cells both because of the pressure on the brain that it produces and the loss of blood flow that occurs to highly oxygen dependent Brain Neurons. Additionally the location of the AVM within the cranial vault although life saving dictates the surgical approach and thus surgical type trauma which impacts recovery.
Often times these folks have some loss of intellectual capacity and never regain primorbid levels. Given the IQ of the Senate this should not be a big issue. Harry Reed had an Occlusive Stroke and he is going to be the Majority Leader.
I give Senator Tim Johnson a 60 to 40 change of recovery to his baseline. May the Good Lord bless him and give him a change of heart after this Mortal Experience...
Dominus Vobiscum,


Anonymous Anonymous said...

I’ve heard about lots of diseases, but arteriovenous malformation is new for me. Yesterday I read about AVM an HULIQ. This sets up a trap…

3:48 AM, December 16, 2006  

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