Gold et al. Clinical Classification System

In 1964, Gold et al. (49) described the variable clinical presentation of VOGMs based on patient age (39,48,49).

• Neonates: Neonates who present with VOGM generally have multiple high-flow AV fistulas. This scenario can lead to high-output heart failure and pulmonary hypertension, manifesting as cyanosis, dyspnea, and/or organ dysfunction.
• Older infants: Older infants with VOGM may have fewer fistulas with lower-flow shunts. These patients may not present with high-output heart failure but may present with macrocephaly, hydrocephalus, developmental delay, failure to thrive, and/or seizures.
• Older children and adults: Older children, adolescents, and adults likely have low-flow shunts. These patients present with headaches, seizures, developmental delay, focal neurological deficits (including cranial nerve disorders), proptosis, epistaxis, subarachnoid hemorrhage, and/or ICH.