PMC7768572_01
(a, b) Non-contrast CT scan and (c, d) AVM located in the left lateral
ventricle.
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Initial non-contrast computed tomography (CT) scan showed all four ventricles full of blood, the lateral ventricles enlarged, suggestive of obstructive hydrocephalus, and a Graeb score of 12 points (Figure 1(a) and (b)). A CT angiogram done shortly thereafter confirmed an AVM located beside the left lateral ventricle (Figure 1(c) and (d)).
(a) Before treatment; (b) after 5 doses of rt-PA; (c) after 7 doses of rt-PA;
and (d) after removal of the drain.
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Ventriculostomy was adequately positioned but demonstrated a poor waveform, and cerebrospinal fluid (CSF) output was judged to be slow at 3 mL/h (Figure 2(a)). Rt-PA was given every 8 h, for a total of seven doses (Figure 2(b)-(d)).
(a, b) Before ventriculo-peritoneal shunt and (c, d) after
ventriculo-peritoneal shunt.
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A CT scan of the head showed an acute hydrocephalus (Figure 3(a) and (b)). CSF shunting; consequently, we decided to establish a ventriculo-peritoneal shunt (Figure 3(c) and (d)). Cerebrolysin 20 mL was administered intravenously daily for another 10, days, from day 31 to day 40.
MRI after 90 days.
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Figure 4 shows that the excess fluid had been drained, and the brain had stabilized.