PMC10446868_01
Initial cerebral angiography (right internal cervical artery, left internal cervical artery, and left vertebral artery).
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A) Frontal view. B) Lateral view. A large arteriovenous malformation with a 43-mm nidus, fed by the right pericallosal artery, right posterior pericallosal artery, and angular artery, is seen in the right fronto-parietal lobe. The draining veins are the great vein of Galen and the cortical vein draining into the superior sagittal sinus. A flow-related aneurysm is seen at the bifurcation of the right pericallosal artery.
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A flow-related aneurysm was located at the bifurcation of the right pericallosal artery (Fig. 1).
Follow-up magnetic resonance imaging during eight years.
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A) Axial unenhanced T1-weighted images. Signs of thrombosis are seen on each image (arrowheads). B) Axial T2-weighted images. The enlarged anterior cerebral artery as the feeding artery (arrowheads) and the draining vein (arrows) showed gradual normalization in size. C) Axial fluid-attenuated inversion recovery images. Brain edema was first detected on the magnetic resonance imaging performed one year later and showed gradual remission over seven years. D) Axial contrast-enhanced T1 or magnetic resonance angiographic images. A gradual decrease in the size of the contrast-enhanced lesion is seen.
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Dx; Diagnosis, yr; years from diagnosis
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Eight years after the initial presentation, the patient developed an epileptic seizure and was admitted to our department, and we found that her MRI revealed signs of another thrombotic event (Fig. 2).
Second cerebral angiography performed eight years later.
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A) Frontal view. B) Lateral view.
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Left internal cervical angiogram in chronological sequence (arterial phase, capillary phase, and venous phase). Complete obliteration of the nidus is observed in the arterial phase. Flow-related aneurysm shows a decrease in size. A slight residual component is observed in the capillary phase (arrowheads). Pooling of the contrast agent is observed in the venous phase (arrows).
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The right internal carotid angiogram and both vertebral angiograms revealed complete obliteration of the AVM, while the left internal carotid angiogram showed a small residual nidus in the capillary and venous phases and a decrease in the size of the flow-related aneurysm (Fig. 3).