Teri Garr recovering from surgery
 

Hello Cherie,
Thank you for posting about Ms.Garr. We heard about it on the news late last night, and she has been in my thoughts all day. I've been wondering if perhaps she had an AVM or this was some kind of incidental finding in addition to her MS. What are your thoughts on this? Thanks for your response.

All the best,
Chris

All I heard on the news last night that she'd had a "close call" and they were glad she was going to be OK. I can't speculate as to the cause of the aneurysm. Many of us have them and never find out till one ruptures or starts to leak.

My guess is , unless it was a recent development, if it was in her brain, docs have known about it for some time as an MRI of the brain is not likely to miss something of that nature.

Thank you for your quick reply. The reason I was asking was because they noted a "small" AVM when I had my first MRI for my diagnosis. I was sent to a Neurosurgeon who told us it was nothing to be concerned about; however it has always been in the back of my mind (quite literally).

AVM and aneurysm are very different. An aneurysm is a weakening in the wall of the vein or artery. The muscle actually deteriorates much as a tire develops a bubble before it pops. An AVM is merely a malformation in the arterio-venous connector (we have these connectors by the millions throughout our bodies). Very common. Rarely requires any treatment.

It's very easy to miss an aneurysm on an MRI tailored to screen for MS. A large aneurysm would likely be seen, but a small (but no less deadly) vascular defect could easily be missed if it was asymptomatic, and thus, not something the radiologist would be looking closely for. An MRA would show it nearly every time.

An aneurysm forms when the vessel wall weakens and cannot withstand the pressure of the arterial bloodflow. It begins to balloon out, which thins it even more, until it finally gives way - like a bubble gum bubble popping.

Cherie...I'm reading that you believe aneurysms and AVMs are relatively common developments - they are not. Nor is an AVM always a simple "malformation". The malformation is often a tangled mass of abnormal vessels which can cause significant problems because it creates a "mass effect" - it physically compresses other structures within the brain. Not a simple matter. Yes, there are incidentally-discovered AVMs which are tiny and asymptomatic, but a true AVM is much different and a lot more problematic.

This AVM is creating a huge area of edema, with a significant mass effect on the lateral ventricle:

http://www.emedicine.com/neuro/image...rrhage_MRI.jpg

I've seen quite a few of these. AVMs which are large enough to become symptomatic usually do require surgery.

Hello Cherie and Rex,
When I originally saw the Neurosurgeon about my AVM, I was told that it was generally a benign condition that had most probably developed in-utero. However, they have been keeping a close watch on it to make sure it hasn't grown any. I was told that there was a very slight possibility that it could develop into an aneurysm, especially during pregnancy because of the increase in blood flow. I have had this link bookmarked, and refer to it frequently. Thus, my reason for questioning the possibility that she could have had an AVM.

We've had a few young ladies in our practice who have had aneurysms at very young ages. I don't believe any of them were due to an AVM to my knowledge. This link is very interesting and is quite comprehensive in it's explanation of what an AVM is and the slight possible consequences of living with this condition.

http://www.ninds.nih.gov/disorders/avms/detail_avms.htm

All the best,
Chris

Rex,
I was not indicating that both AVM and aneurysms are either common or benign. I was responding to Chris' Description of her AVN as being not problematic but being watched, and to the fact that a large enough AVM or aneurysm in the brain that would cause a problem being most likely picked up on MRI.

I also know that when Teri spoke to us on last year's MSF, she mentioned that she'd had an MRI, MRA, SPECT, and PET so I'm sure they were aware of the aneurysm if it was in the brain.

I don't want to split hairs with you on this...I just felt that you were trivializing AVM's a bit, and I wondered where you got your information about their respective prognoses and how common AVMs and/or aneurysms are. The presumption that an MRI would detect a brain aneurysm - many of which are very small - well, I just didn't agree on that.