Presentation
Headache and seizures.
Patient Data
A bunch of dilated vessels is noted involving right fronto-temporo-parietal regions showing T2 flow voids as well as T1 hyperintense foci and multiple nidal aneurysmal dilatations. This is associated with multiple aneurysms at the cavernous and pre-communicating segments of right ICA with relative dilatation of the intra-cranial right ICA. It exerts mass effect on the right lateral ventricle. It measured about 7.7 x 5.5 cm at maximum dimensions.
Arterial supply: many feeders including cortical branches from the right middle cerebral and right anterior cerebral arteries which are seen dilated.
Superficial venous drainage: multiple dilated cortical veins are draining into the superior sagittal sinus.
Deep venous drainage: into right subependymal and septal veins.
Case Discussion
Multiple hyperintense foci on T1WI reflect hemorrhagic changes. This along with other features are consistent with a large arteriovenous malformation. According to Spetzler-Martin grading of the AVM, it is considered grade V.