AVM Case - nicely annotated and full story
CLINICAL SCENARIO: Sudden onset of hemiplegia and seizures in a young female (at the time of unknown identity and age).
IMAGING FINDINGS:
There is a large intraparenchymal hematoma in the left frontal lobe with extension into the ventricular system and large amounts of blood within the left lateral, third, and fourth ventricle.
Significant mass effect on the brain parenchyma by the hematoma associated with subfalcine herniation, obliteration of basilar cisterns, and downward herniation of the brain.
There is edema surrounding the intraparenchymal portion of the hematoma with no evidence of large vascular territory infarct or peri-hematoma infarcts.
The ventricular system remains undistended, although the patient is at increased risk of developing hydrocephalus.
CT angiographic images of the circle of Willis demonstrates a circumscribed focus of contrast enhancement within the hematoma measuring 6 mm in diameter with surrounding abnormal tangle of fine vessels, which drains to the superior sagittal sinus with an appearance in keeping with an Arteriovenous malformation - AVM. There is arterialization of the veins overlying the superficial left frontal lobe.
There is preservation of the margins of the circumscribed focus of hemorrhage within the hematoma on the delayed images, with no increase in size which is suggestive of presence of an intranidal aneurysm/ruptured venous pouch.
There is enlargment of the Left ACA, which most likely serves as a feeding vessel to this AVM.
IMPRESSION:
Large intraparenchymal hematoma in the left frontal lobe causing significant mass effect, intraventricular extension, and herniation.
Tangle of abnormal vessels with superficial drainage to the superior sagittal sinus with arterialization of veins overlying the left frontal lobe is in keeping with an AVM. Enlarged left ACA feeders. A 6 mm focus of contrast enhancement within the
Significant mass effect on the brain parenchyma by the hematoma associated with subfalcine herniation, obliteration of basilar cisterns, and downward herniation of the brain.
There is edema surrounding the intraparenchymal portion of the hematoma with no evidence of large vascular territory infarct or peri-hematoma infarcts.
The ventricular system remains undistended, although the patient is at increased risk of developing hydrocephalus.
CT angiographic images of the circle of Willis demonstrates a circumscribed focus of contrast enhancement within the hematoma measuring 6 mm in diameter with surrounding abnormal tangle of fine vessels, which drains to the superior sagittal sinus with an appearance in keeping with an Arteriovenous malformation - AVM. There is arterialization of the veins overlying the superficial left frontal lobe.
There is preservation of the margins of the circumscribed focus of hemorrhage within the hematoma on the delayed images, with no increase in size which is suggestive of presence of an intranidal aneurysm/ruptured venous pouch.
There is enlargment of the Left ACA, which most likely serves as a feeding vessel to this AVM.
IMPRESSION:
Large intraparenchymal hematoma in the left frontal lobe causing significant mass effect, intraventricular extension, and herniation.
Tangle of abnormal vessels with superficial drainage to the superior sagittal sinus with arterialization of veins overlying the left frontal lobe is in keeping with an AVM. Enlarged left ACA feeders. A 6 mm focus of contrast enhancement within the
AVM, consistent with intranidal aneurysm/ruptured venous pouch.
Diagnostic angiogram could be considered to further characterize the underlying vascular abnormality...
Diagnostic angiogram could be considered to further characterize the underlying vascular abnormality...
Accession: CL0052
Study description: CT Head and Neck Angio
