Cerebral arteriovenous malformation with lobar haemorrhage

Case contributed by Dr Andrew Dixon

Presentation

Thunderclap headache

Patient Data

Age: 55
Gender: Male

Acute 18 x 43 x 21 mm left occipital lobe intraparenchymal haemorrhage with intraventricular extension into both occipital horns and subdural extension along the falx and tentorium. There is also subarachnoid blood present in the left pre pontine, interpeduncular, left cerebellopontine angle and ambient cisterns. 

Circle of Willis CT angiogram confirms the presence of a left occipital arteriovenous malformation at the posteromedial aspect of the haematoma. The malformation is fed by a mildly enlarged left posterior cerebral artery and drains via a dilated vein of Galen into the straight sinus.

Case Discussion

An example of acute lobar haemorrhage due to cerebral arteriovenous malformation. This case emphasises the importance of performing post contrast imaging in the setting of lobar haemorrhage to assess for an underlying mass or arteriovenous malformation. In elderly patients with known cerebral amyloid angiopathy post contrast imaging can probably be avoided. 

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Case information

rID: 35598
Case created: 13th Apr 2015
Last edited: 16th Feb 2017
Inclusion in quiz mode: Included

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