Arteriovenous malformation (cerebral)

Case contributed by A.Prof Frank Gaillard

Presentation

Headache.

Patient Data

Age: 55 Years
Gender: Female

An acute intracranial haemorrhage straddling the genu of the corpus callosum extends into the ventricles, with blood filling the lateral, third and fourth ventricles. There is mild ventricular dilatation. There is a nest of abnormal heterogeneous density possibly representing vessels centred in the anterior interhemispheric fissure suggesting an AVM. 

Acute intracranial haemorrhage straddling the genu of the corpus callosum and extending into the ventricles is again demonstrated. Anterior interhemispheric arteriovenous malformation is again demonstrated, nidus approximately 2.5 x 2.2 x 2.5 cm in size, with supply predominantly from the left anterior cerebral artery and draining to the superior sagittal sinus.

The draining veins have not been completely imaged on MRA (not shown). T2/FLAIR hyperintensity surround the haematoma, compatible with reactive oedema. Sulcal T2 FLAIR high signal in both cerebral hemispheres may reflect subarachnoid haemorrhage or hyper-oxygenation. No hydrocephalus. No restricted diffusion.

Conclusion:

Arteriovenous malformation measuring ~2.5 cm in greatest diameter with supply predominantly from the left ACA and draining to the super sagittal sinus. 

Case Discussion

In a younger patient, a primary cerebral haemorrhage needs to prompt a carful search for an underlying cause. The younger the patient, the more likely there is an underlying cause, and the more likely it is vascular. 

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Case information

rID: 40070
Case created: 6th Oct 2015
Last edited: 6th Feb 2016
Inclusion in quiz mode: Included

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