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Is Cranial Bruit On Auscultation A Symptom Of Arteriovenous Malformations?

Posted on Fri, 31 Jul 2015

Question: My son is 14 months. His anterior fontanelle is still wide open, and throbs uncontrollably. He has basilar artery occlusion, cerebral degeneration, cerebral infarction due to thrombosis of the cerebral, and was recently diagnosed with a stroke. He has hypoplastic left heart syndrome, and has had the norwood and the XXXXXXX He has been in second degree heart block since he was in untero, and has a pacemaker as well. I am really concerned about his head. What are the chances of it being an AVM, and how is this repaired?

Answered by Dr. Archana Verma (1 hour later)

Brief Answer:
Cranial bruit on auscultation may suggest an AVM

Detailed Answer:
Hi
Welcome to the HCM

I have gone through your question and understand your concerns. An open anterior fontanella can be normal at this age. But it needs assessment if large in size and throbs uncontrollably. It's not possible to tell you the chances of it being due to any AVM or not without examination of the child.

A cranial bruit on auscultation is suggestive of arteriovenous malformations( AVM). But this needs to be assessed by pediatric neurologist on clinical examination. An ultrasound cranium may be useful initial investigation since it can be done with out any sedation.

Definitive investigation to detect AVM are MRI and cerebral angiography.

Depending on the size, location and depth of malformation, the treatment can be surgery, radiotherapy or embolisation.

I would be happy to help you with any further questions.
Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Archana Verma (3 hours later)

He had a CT done of the back of his head a little over a month. They were checking on the calcifications and thrombuses. He has beennunder anesthesia several times, but that time, threw him into vtach. With hisbheart condition, they chose jor to go that route. He cant have an MRI due to having a pacemaker, which is why they chose to do an ultrasound. He already sees two neurologists, but beither have ever mentioned anything about his latge fontanelle. It was our neonatologist who kentioned it s couple weeks back. He is in the NICU for a long time, so he still follows up with them. My concern is that they wont be able to catch anything serious just using ultrasonography

Answered by Dr. Archana Verma (21 minutes later)

Brief Answer:
cranial bruit is an auscultation finding

Detailed Answer:
In this scenario, I would advice you to go with the examination finding to rule out any bruits.

If there were any such findings, your neonatologist must have told you by now. If not, then there is no need to go for investigation which can be more detrimental than useful.

Poor general health might be the cause of his large fontanella since it leads to poor bone growth.
So, I would recommend you to let him recover from other major conditions at present and don't worry about the rare possibility of AVM.

TAKE CARE

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Above answer was peer-reviewed by : Dr. Prasad