Pediatric Cerebrovascular Disorders
Cerebrovascular malformations can be significantly different in children than in adults. At OHSU Doernbecher Children's Hospital, our pediatric specialists treat only children. They work together to develop a treatment plan specific to each child’s needs. We offer:
- World-class pediatric neurologists and neurosurgeons who can treat any type of cerebrovascular anomaly, from the relatively simple to the highly complex.
- Expert pediatric neuroradiologists and endovascular specialists with the latest imaging technology for diagnosing, treating and monitoring your child’s condition.
- A team approach to care, with pediatric specialists who collaborate from diagnosis through recovery.
Understanding cerebrovascular malformations
Cerebrovascular malformations are conditions involving the brain (“cerebro”) and blood vessels (“vascular”) such as veins and arteries. Some types rarely cause problems, while others require monitoring or surgery. Many are discovered only after an MRI scan is done for another reason. Types include:
In these malformations, also called AVMs, blood vessels in the brain or spinal cord are tangled and abnormally connected.
Normally, arteries carry oxygen-enriched blood from the heart and lungs to the rest of the body, and veins bring the blood back to be replenished. Arteries and veins are connected by smaller blood vessels called capillaries. In AVMs, arteries and veins are snarled and directly connected, disrupting proper blood flow.
Most AVMs are present at birth. Some AVMs cause no symptoms, and others are diagnosed after a child has bleeding in the brain, a stroke or a seizure. AVMs can cause damage by bleeding into the brain, by lowering the amount of oxygen that reaches the brain, and by pressing on the brain or spinal cord. Surgery may be needed.
A rare but especially severe form, a birth defect called vein of Galen malformation, involves a large vein deep in the brain. This type is often accompanied by hydrocephalus, a buildup of fluid in the brain, and signs of heart failure.
In moyamoya disease, first described in Japan, large arteries at the base of the brain narrow, restricting blood flow. Smaller arteries expand to compensate, forming a pattern that looks like a "puff of smoke" — moyamoya in Japanese.
This rare, progressive disorder affects mostly children. It's often diagnosed after a child has a stroke caused by a lack of blood flow to part of the brain, or a transient ischemic attack (TIA or mini-stroke).
Because moyamoya gets worse over time, early diagnosis is important. Surgery to bypass blocked blood vessels and restore blood flow is necessary to avoid problems such as brain damage from repeated strokes.
Cavernous malformations, also called cavernomas or cavernous angiomas, are abnormal clusters of small, enlarged blood vessels with pockets or “caverns” of slow-flowing blood. This disorder has several subtypes, including some that run in families.
These malformations generally pose less risk than AVMs, but they can sometimes bleed and cause seizures. Surgical removal is sometimes recommended.
In these malformations, also called developmental venous anomalies or DVAs, small veins drain into and radiate from a larger vein. They are present at birth and relatively common, affecting as many as one in 50 people. They generally cause no symptoms and usually do not require treatment.
These are small clusters of abnormally enlarged capillaries in the brain. They usually cause no problems and generally require no treatment.
This rare condition involves a malformation in which veins inside the brain’s coverings are abnormally connected to the drainage pathways of veins outside the brain. This sometimes produces a blue birthmark or soft mass on a child’s head.
These anomalies can be present at birth or can result from injury. Surgery may be recommended if they pose a risk of bleeding.
These are abnormal bulges or weak areas in the wall of a blood vessel in the brain. They are rare in children. They require surgical repair because they pose a significant risk if they burst.
Symptoms vary widely depending on the type of malformation. Some mild cases cause no symptoms, while others pose a growing risk of stroke and other problems over time. Generally, symptoms of a cerebrovascular malformation can include:
- Severe headache
- Neck stiffness
- Muscle weakness or paralysis on one side of the body
- Problems with speech, vision, coordination or movement such as walking
- Abnormal sensations such as numbness or tingling
- Confusion or problems with memory and learning
- Transient ischemic attack (TIA or mini-stroke)
Doernbecher Children’s Hospital offers a full range of the latest diagnostic tools for spotting and monitoring these malformations, including:
Magnetic resonance imaging, or MRI, uses radio waves (not radiation, like X-rays), a large magnet and a computer to create detailed images of the body's internal structures.
Single photo emission computed tomography, or SPECT fusion imaging, can give doctors a high-resolution look at the brain's blood flow.
In this test, scans are taken after a special dye is injected to highlight the brain's blood vessels.
Computed tomography imaging, also called a CT scan or CAT scan, uses an X-ray beam that circles the body to create cross-section and three-dimensional views. Sometimes patients are given intravenous dye to help features stand out. CT scans provide detailed images of bone and soft tissues, including blood vessels. Doernbecher introduced technology to reduce the radiation exposure from CT scans by up to 60 percent.
An electroencephalogram or EEG uses small metal electrodes attached to the scalp to measure the brain's electrical activity. This can help show abnormalities in the brain's functioning.
A mild malformation may require no treatment. Other treatment options include:
- Monitoring: Sometimes the best option is to monitor a malformation with scans at regular intervals to make sure it's not changing or causing problems. Our care team at Doernbecher Children's Hospital can guide you and your child through appointments and answer any questions. We also offer the highest level of technology and expertise in pediatric imaging.
- Fetal care: Doernbecher's Fetal Care Program can play a role in diagnosing some malformations, such as vein of Galen malformation, before birth. This can help doctors plan treatment.
- Surgery: Some malformations require surgical removal or repair. “Revascularization surgery,” for example, opens or bypasses the malformation to restore proper blood flow. If surgery is needed, Doernbecher Children’s Hospital offers first-rate expertise. Our pediatric neurosurgeons provide excellent outcomes for the most complex malformations and for rare disorders such as moyamoya disease. They are highly skilled in the latest surgical techniques, including minimally invasive, computer-aided approaches.
- Rehabilitation: Sometimes a malformation isn't discovered until after a child has a stroke, seizure or another problem. If needed, our team of physical therapists, speech therapists, neuropsychologists and other rehabilitation experts can help your child recover and reach his or her full potential.
Doernbecher Children’s Hospital offers expert, complete care for conditions related to cerebrovascular malformations.
Some patients with cerebrovascular conditions have seizures. Doernbecher’s Pediatric Epilepsy Center — the only children’s comprehensive epilepsy clinic in Oregon — offers the latest in monitoring, imaging and treatment.
Some patients with cerebrovascular conditions have strokes or transient ischemic attacks (mini-strokes). Our Pediatric Stroke Program brings specialists together to provide full assessment, treatment, rehabilitation and monitoring services.
In rare cases, a malformation can be associated with hydrocephalus, in which too much cerebrospinal fluid — the liquid that cushions the brain and spinal cord — builds up and puts pressure on the brain. Our pediatric specialists offer world-class expertise and excellent outcomes in treating this condition.
It’s important to note that these pages, while providing good information about these conditions, are not specific to pediatric patients. If your child has a cerebrovascular malformation, please see your Doernbecher care team with questions and concerns.
- Arteriovenous Malformations and Other Vascular Lesions of the Central Nervous System Fact Sheet and Arteriovenous Malformation Information Page, National Institute of Neurological Disorders and Stroke
- Moyamoya Disease Information Page, National Institute of Neurological Disorders and Stroke
- Cerebral Cavernous Malformation Information Page, National Institute of Neurological Disorders and Stroke
- Vascular Malformations of the Brain, National Organization for Rare Disorders
- Cerebral Aneurysms Information Page, National Institute of Neurological Disorders and Stroke
- Angioma Alliance, an advocacy group with support and information for those affected by cavernous malformations
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Doernbecher Children’s Hospital
700 S.W. Campus Drive
Portland, OR 97239
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