Intraventricular hemorrhage

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Follow up of intraventricular hemorrhage after previous evacuation 2ry to subependymal vascular malformation.

Patient Data

Age: 5
Gender: Female
MRI

MRI brain

An ill-define tuft of vascular structure is seen involving the medial aspect of the high fronto-parietal region. This  tuft is converging down along the ependymal surface of the frontal horn of the lateral ventricle. The tuft is associated with a 2.5mm enhancing rounded component at just subependymal location. This showed T2 hyper-intensity and hypo-intense rim.

Intraventricular hemorrhage is seen. This shows subacute blood products of T1 and T2 hyperintensity filling the frontal horn, body and occipital horn.

CT

CT cerebral angiographgy

This vascular tuft is draining into ipsilateral deep veins, namely the caudate and septal veins. The ipsilateral dilated veins are prominent (Thalamostriate, internal cerebral vein, MCV and BVR). The intra-ventricular hemorrhage is ill defined in CT. Left posterior parietal craniectomy defect is seen with tract of previous drainage shunt at left lateral ventricle.

Case Discussion

This case represents intra-ventricular subacute hemorrhage with underlying subependymal flow vascular malformation. Digital substraction angiography (DSA) is useful for more detailed arterial and venous connections to differentiate possible AVM from the less likely DVA. 

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Case information

rID: 53897
Case created: 12th Jun 2017
Last edited: 2nd Aug 2017
Inclusion in quiz mode: Included

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