1. Hyperacute neuroplasticity, the reorganization of the brain's functional structure, occurs in human subjects following acute focal injury.
2. Early development of functional reorganization in the brain following injury predicts clinical neurological recovery and rehabilitation.
1. Improved anatomical localization and volumetric analysis of cerebral parenchyma at risk during treatment of cerebral AVMs.
2. Evaluation for patterns of early neuroplasticity with functional magnetic resonance imaging (fMRI) and correlation with superselective Wada clinical testing protocol.
During the first year of the study (the "Vanguard" period), we will optimize the MRI sequences used to obtain functional brain maps in patients with brain AVMs due to artifacts that can occur in relation to extreme blood flow. During the next two years of the study (the "Enrollment" period), patients will undergo both evaluation and treatment in the MR environment. Evaluation for hyperacute neurplasticity will include a comparison of global brain volumes of activity and patterns of activity (centroids) for each function mapped. Functional maps will be compared with neuropsychological and behavioral testing data collected during the treatment of AVMs according to IRB-approved protocols. In conjunction with and using methodology previously described by Joy Hirsch, Ph.D., et al., we will evaluate for migration of function across anatomic structures representing essential functional networks and for commonality of this process across the study subjects.