Cerebral arteriovenous malformation
5 days of severe pulsatile headache. Neurological examination was normal.
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There is abnormal serpentine vascular structures in the anterior lateral aspect of left frontal lobe in a wedged shaped configuration with the apex of the lesion abutting the frontal horn of lateral ventricle and the base at the left frontal cortex.
The abnormal vessels are noted to extend to the left sylvian fissure. Vessels are also noted to extend to involve the genu of the left corpus callosum.
There are at least 2 large feeding arteries arising from ACA and one feeding artery arising from MCA.
There is a draining vein to the sagittal sinus as well as to the left transverse sinus and the internal cerebral vein on the left.
Left frontal AVM as described. There are no features of gliosis identified. cerebral AVMs are the most common vascular malformation and are asymptomatic in 15% of patient. Headache, seizures and ischemic events are the possible presentations. Hemorrhage can be a complication in 65% of the patients.
Given its location in the dominant lobe and the size of greater than 3cm and deep venous drainage, it would be graded as 4 according to spetzler-martin AVM grading system.