Presentation
10 days ago presented with headache, nausea, and vomiting. Aphasia, disorientation, facial asymmetry, left hemiparesis.
Patient Data
A large heterogeneous lesion composed of serpentine structures with blood attenuation, consistent with vessels seeming to drain via an enlarged internal cerebral vein into the vein of Galen. Hydrocephalus and effacement of sulci.
Centered on the right basal ganglia, internal capsule and thalamus is a large (6 x 3 x 4 cm) heterogeneous lesion with multiple flow voids. It is supplied by the middle cerebral artery and drains via markedly enlarged internal cerebral veins.
Features are of a cerebral arteriovenous malformation, Spetzler-Martin grade 5.
Case Discussion
This is a typical appearance of a large arteriovenous malformation with the highest Spetzler Martin grade of 5: large nidus >6 cm, eloquent brain involvement and deep drainage.