Presentation
Recent onset of recurrent fitting episodes.
Patient Data
Presence of multiple tubular-like tortuose hyperdense lesions occupying the left fronto-temporal region to represent the nidus. Some of these lesions have peripheral mural calcifications. A large tubular hyperdense structure extends from the lesions into the left ambient cistern and left quadrigeminal cistern and further into straight sinus, suggestive of draining vein.
These lesions exert mass effect as depicted by right sided midline shift and partial effacement of left lateral ventricle.
Large nidus of malformed vessels with serpiginous appearance (bag of worm) involving almost whole left frontal lobe. The nidus measures 6.3x6.3x4.9cm (APxWxCC).
Case Discussion
Large left frontal arteriovenous malformation (Spetzler-Martin grade V, 3 for large nidus, 1 for deep venous drainage, and 1 for nidus situated in the eloquent brain). No MR evidence of hemorrhage, aneurysm or thrombosis.
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