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In non enhanced CT scan a subtle ill defined area of hyperdensity is defined in the left parietal-occipital region, no mass effect is noted, no hemorrhage or calcifications. There is also a subtle linear hyperdensity in the ipsilateral parietal lobe. The rest is unremarkable.
In the contrast enhanced phase we can appreciate an intense uptake of iodinated contrast in the same region, with multiple tubular images corresponding to a nidus of blood vessels. The lesion is compatible with an AVM. The arterial supply appears to be provided directly by a branch of the middle cerebral artery. Note the engorged principal vein that drains the nest and appears to drain to the internal cerebral veins ar/or the Vein of Galen (3.75 mm slices, thinner slices technically not available) through a tortuous vein.
The nidus measures 35 mm, it is located in an eloquent brain area (parietal-occipital) and has deep and superficial venous drainage. This lesion corresponds to a grade 4 Spetzler Martin classification.