Presentation
Heard to have fallen over. Found by son unresponsive. ? traumatic head injury
Patient Data
Large lobar intracerebral hematoma involving the right temporal lobe. A small volume of perihaematomal edema. A small amount of localized subarachnoid hemorrhage. Right cerebral convexity acute subdural hemorrhage. No intraventricular hemorrhage.
Significant mass effect with effacement of the right cortical sulci and lateral ventricle, right uncal herniation and marked leftward midline shift. Left lateral ventricle obstructive hydrocephalus.
Areas of calcification within the hematoma are in keeping with an arteriovenous malformation.
No evidence of small vessel disease.
Right temporal arteriovenous malformation with areas of coarse calcification. Supply is from the right middle cerebral artery. Drainage appears largely superficial to the superior sagittal sinus.
Case Discussion
The imaging shows a spontaneous intracerebral hemorrhage secondary to an arteriovenous malformation. The right-sided subdural hematoma is likely due to the adjacent arteriovenous malformation rather than trauma given its location and the lack of evidence of traumatic scalp soft tissue changes.
macrovascular lesions, such as arteriovenous malformations, underlie 10-15% of spontaneous intracerebral hemorrhage
early identification of such abnormalities is important to allow appropriate treatment
specific features on non-contrast CT of an underlying macrovascular lesion include calcifications within or along margins of an intracerebral hemorrhage 1. However, these non-contrast CT findings are not sensitive and their absence does not exclude a macrovascular lesion
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