Arteriovenous malformation

Case contributed by Eid Kakish
Diagnosis almost certain

Presentation

Chronic complaints of headaches with sudden onset seizure and collapse.

Patient Data

Age: 9 years
Gender: Male
mri

A rather rounded area of serpiginous, tortuous signal voids measuring 3 x 3 cm is seen in close proximity to the occipital horn of the right lateral ventricle and splenium of corpus callosum, consistent with an arteriovenous malformation (AVM). A large draining vein is seen draining into the straight venous sinus.

The aforementioned AVM is surrounded by an irregular area of subacute blood, measuring 2 x 7 cm, representing a subacute hematoma, closely related to, and compressing the body and occipital horn of the right lateral ventricle.

A significant blooming artefact can be clearly appreciated on axial gradient echo.

Levelling of subacute blood is seen in the frontal, temporal and occipital horns of the right lateral ventricle and the fourth ventricle.

A small amount of subacute subdural blood is seen in the right occipital parasagittal region.

Case Discussion

The whole picture is consistent with a right parasagittal AVM complicated by hemorrhage, forming a large late subacute hematoma in very close proximity to the right lateral ventricle, rupturing into the ventricular system.

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