An arteriovenous malformation (AVM) of the brainstem may cause sudden death. It may not be immediately obvious at autopsy if the brainstem is not sectioned.
The malformation may be located as:
(1) dural
(2) superficial
(3) deep
The lesion may be asymptomatic or cause symptoms such as:
(1) dizziness
(2) excessive daytime somnolence
(3) pseudobulbar palsy
(4) dyspraxic handwriting
(5) recurrent syncope
(6) headache
(7) seizures
The lesion can be identified on imaging studies of the posterior fossa, even after death.
Sudden death can occur when the lesion ruptures causing hemorrhage into the brainstem or into the subdural space, which in the posterior fossa is limited.
The differential diagnosis includes brainstem tumors, usually gliomas.
In some patients the lesions can be treated surgically or by endovascular means, but deep lesions may be inoperable.
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