Cerebral arteriovenous malformation

Case contributed by Dr Hanisalam

Presentation

Previously well. Sudden headache, vomiting and left sided weakness.

Patient Data

Age: 50 years
Gender: Male
Modality: CT

Non-contrast CT of the brain demonstrates a large right temporo-parietal haemorrhage. It is associated with moderate midline shift. 

Anterior and posterior to the haematoma are nodular regions of lower attenuation (lower than the thrombus, similar to dural venous sinuses) with a single calcification. 

Modality: Annotated image

Large right temporo-parietal haemorrhage ( * ). Anterior and posterior to the haematoma are nodular regions of lower attenuation (yellow - lower attenuation than the thrombus, similar to dural venous sinuses) with a single calcification (green arrow) which is separate form the displaced choroid plexus calcification (red arrow). 

Cerebral angiogram

Modality: DSA (angiography)

Right common carotid artery angiogram demonstrates a ~1.5cm nidus supplied predominantly by the right middle cerebral artery. The AVM has superficial drainage via markedly enlarged cortical veins, which drain in the dural sinuses. No deep drainage was identified. 

Modality: Annotated image

The nidus (*) is supplied by middle cerebral artery (MCA) branches (red) and drains via numerous enlarged cortical veins (blue CV). 

Case Discussion

This case illustrates the typical and relatively subtle appearances of an AVM on non-contrast CT in the setting of a haemorrhage. An underlying lesion should always be suspected and sought when a young patient presents with a haemorrhage.

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Case Information

rID: 13586
Case created: 23rd Apr 2011
Last edited: 9th Jan 2016
Inclusion in quiz mode: Included

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