Cerebral arteriovenous malformation

Case contributed by Dr. Mohammad Al-Tibi

Presentation

Poorly responsive. Headache and right-sided weakness. On examination, the Glasgow Coma Score was 10/15 and reduced power right leg.

Patient Data

Age: 30 years
Gender: Female
CT

Initial plain CT brain

Intraparenchymal bleeding in the left frontoparietal region with associated vasogenic edema. In close proximity to the bleed, multiple calcified vessels can be seen in the left parietal cortex near the vertex likely representative of a clump of arteriovenous malformation.
Mass effect demonstrated by cortical sulcal effacement, compression of the left lateral ventricle and right midline shift.

 

CT

CT intracranial angiogram

Large cerebral arteriovenous malformation with its nidus in the left frontoparietal region. The left anterior cerebral artery is disproportionately large tracing to its pericallosal branch. This is felt to be the feeding artery. Multiple dilated draining cortical veins of Trolard can be appreciated draining to the dilated superior sagittal sinus. A number of other dilated draining sinuses are seen including left thalamostriate vein, internal cerebral vein and vein of Gallen.

There is a number of incidental aneurysms including two basilar artery saccular aneurysms.

Case Discussion

Classic supratentorial cerebral arteriovenous malformation causing a large intraparenchymal cerebral bleed in a young patient. 

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Case information

rID: 79677
Published: 2nd Jul 2020
Last edited: 7th Oct 2020
Inclusion in quiz mode: Included

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