15 Year Old Girl with Chronic Headaches: Case of an AVM Written by James D. Okun, MD

Posted on January 7, 2018 by Jeyran Main

15 Year Old Girl with Chronic Headaches: Case of an AVM Written by James D. Okun, MD

It is time for James Okun to pick our brain and inform us on some important medical matters. You can show your support by buying his books or leaving a comment here if you like- Jeyran Main

James D. Okun, MD is a Phi Beta Kappa graduate of Duke University and of the Albert Einstein College of Medicine in New York. He is the co-author of The History of New Innovations in Modern Medicine: New Thought and the Threat to Traditional Medicine

Fifteen-year-old TG had been having headaches for over two years. Her Pediatrician had been treating her with antibiotics, decongestants, and antihistamines but to no avail and she kept complaining of severe headaches.

I first saw her in my family practice clinic when her doctor was on vacation. After hearing her history and doing a complete physical examination, something just didn’t seem right.

I sent her for a CT scan of her brain. The results which came back were shocking. Not only were her headaches not caused by sinus problems, they were being caused by a rare (less than 1% of the general population http://www.strokeassociation.org) massive congenital malformation in the brain known as an arteriovenous malformation (AVM).

In this condition present from birth (congenital), normal capillary connections between arteries and veins are absent with veins and arteries directly connected together in a tangled mass in the brain.

The danger of this condition is that the high pressure of the arteries is flowing through the thinner walled veins and so the vessels in the mass become dilated and weakened and can rupture causing bleeding and even death. The usual presentation in children is often only after there has been hemorrhaging in the brain which can cause symptoms (headache, seizures, problems with walking, vision, memory or speech).

In TG’S case, the jumbled mass of arteries and veins had grown so large that it now involved an entire cerebral hemisphere (half of the brain). Per the radiologist who examined the CT Scan, the mass was the largest ever seen in the south, was in imminent danger of exploding and if not treated immediately probably would kill the patient.

No Pediatric Neurosurgeon in the state of Louisiana would touch the case and the AVM was even too large for the neurosurgeons at Vanderbilt University Medical Center in Tennessee.

After some really quick research on Pediatric Neurosurgeons who had successfully operated on such a huge AVM, and after coordinating with her insurance coverage, TG was emergently flown out to Stanford University Medical Center where a skilled Pediatric Neurosurgeon operated on the vascular mass in her brain, treating the AVM and saving her life.

TG could have easily died if the AVM had exploded. Only by the grace of God was her life spared. An article in her local newspaper in Denham Springs, Louisiana back in the early 1990’s told her story and how she was able to recuperate and return to a normal life as a high school student after the operation.

The moral of the story is never underestimate a child’s medical complaints, especially if they are longstanding.