An AVM, or arteriovenous malformation, is not something 18-year-olds usually worry about. But one day Chantal Poole, who had suffered from migraines since she was 13, had what she thought was the worst migraine of her life. It turned out to be a brain AVM that had caused a bleeding in her brain.
An AVM is a tangle of abnormal and poorly formed blood vessels that have a higher rate of bleeding than normal vessels. AVMs can occur anywhere in the body.
“That day at work I had a totally different pain,” Chantal says, “It was so bad that I lost vision in my right eye and I became weak. When I got off from work I had to sit in the lobby until my mother came and got me. I couldn’t drive because I couldn’t see.”
Thinking her symptoms were a bad migraine, Chantal and her mother went to University of Michigan’s Emergency Department the next day.
A diagnosis of AVM and pregnancy
Complicating the situation was the fact that Chantal was newly pregnant. The Neurosurgery team chose diagnostic tests carefully. And when the team came in to talk with Chantal and her mother, they had shocking news.
“They told me I had a cerebral AVM. They explained that the bleed happened in the area of the brain that controls the vision—and that I would need brain surgery.” The team recommended a craniotomy—surgically opening the skull to make the repair.
Because open brain surgery seemed so daunting to the expectant mother, she opted for a less invasive but equally risky procedure in which we thread a tiny catheter from the blood vessel in the groin to the blood vessels of the brain AVM. Once the catheter is in the AVM blood vessel, we inject “glue” to close off that vessel. We continue the process until the team plugs all of the abnormal vessels.
The leader of her Neurosurgery team, Aditya S. Pandey, M.D., says, “This type of procedure is called an endovascular embolization, and it often leads to a cure of the AVM.”
Dr. Pandey recommended that Chantal deliver before having the embolization. Chantal had a C-section and delivered a healthy baby girl. “They didn’t want me to push with her because it could rupture the AVM,” Chantal says.
A great recovery
The birth went well, and the embolization had no complications. However, on follow up, some of the AVM blood vessels opened up, and Dr. Pandey recommended that Chantal have the open surgery to remove the AVM. This would prevent it from coming back.
After discussing it with her family, Chantal underwent the open surgery. Dr. Pandey says, “She was cured of the AVM, has no vision problems and doesn’t need to take any medications. At this point, we see her once a year for followup.”
“I love Dr. Pandey and his entire team,” Chantal says. “He’s super awesome. He knew that I was putting off having that brain surgery, but he talked to me like a friend. He was super sincere and concerned. And he was really passionate about what he was saying.
“I feel like if I hadn’t gone to the ER and hadn’t had Dr. Pandey’s help, it could have been fatal for me.”
Today, Chantal works closely with the Neurosurgery Department as a patient services assistant, a job she has held since November 2014.
Chantal’s daughter will be 6 years old this summer. And now, they have the best gift of all: time together.
- Read about how the University of Michigan treats cerebral arteriovenous malformation (AVM)
- Read more about clinical neurosciences at the University of Michigan
Aditya S. Pandey, M.D., is Associate Professor of Neurological Surgery and the Surgical Director of the Comprehensive Stroke Center. He received his medical degree from Case Western Reserve University School of Medicine. He completed his residency and a fellowship in vascular/endovascular surgery and interventional radiology at Thomas Jefferson University Hospital. His clinical interests are in aneurysms, AVMs, extracranial and intracranial stenosis, neurovascular disorders, tumors, and brain tumors.
The University of Michigan’s multidisciplinary clinical neuroscience team is made up of more than 70 nationally recognized neurologists, neurosurgeons and many other specialists who have led the way in brain, spine and nervous system care for close to 100 years. Today, patients can access services found at only a handful of facilities and may participate in innovative treatments conducted with the latest research. Neurology and Neurosurgery at the University of Michigan Health System have been recognized by U.S. News & World Report numerous times for excellence in patient care.