Cerebral arteriovenous malformation
Cerebral arteriovenous malformations (CAVM's) are a common form of cerebral vascular malformation and are composed of a nidus of vessels through which arteriovenous shunting occurs. They tend to be solitary in the vast majority of cases (>95%). The origin of arteriovenous malformations remains uncertain, although they are thought to be congenital.
The Spetzler-Martin AVM grading system allocates points for various features of intracranial AVM's to give a score between 1 and 5. This case represents the extreme end of the scale - a grade 5 AVM.
Catheter angiography was performed following this acute bleed - the nature of the AVM on MRI was confirmed:
- huge left parieto-occipital AVM
- smaller right cortical parietal vascular lesion – this appears separate adjacent to the VP shunt entry point. This subsequently bled.
- distended cortical veins and periventricular appearances are suggestive of cerebral venous hypertension, and perhaps responsible for the patient's decline prior to the cortical hemorrhage.
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