PMC2713990_01
Initial radiologic studies of an AVM in a 41-year-old man with sudden onset of headache and blurred vision.. A. Enhanced CT scan shows a large intracerebral hematoma (arrows) in the right occipital lobe. Clearly enhanced tubular structures (arrowheads) are seen in the medial occipital lobe adjacent to the hematoma.. B. Axial gadolinium-enhanced T1-weighted MR image suggests that the hematoma i.e. is not certain; thus, 'suggests that is iso-intense, with a peripheral high-signal-intensity rim (arrows) secondary to the presence of methemoglobin'. The tubular structures representing the AVM are seen as signal voids (arrowheads).. C. Early-phase left vertebral angiogram depicts an AVM supplied by the right posterior cerebral artery (arrow).. D. Delayed-phase left vertebral angiogram shows an early-draining single vein (arrow) which drains into the right transverse sinus (arrowhead). Note the tortuous proximal portion of the early draining vein (curved arrow).
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F1
The results of neurological examination were unremarkable, but contrast-enhanced CT scanning demonstrated a large intracerebral hematoma in the right occipital lobe accompanied by enlarged and tortuous vascular structures (Fig. 1A). At contrast enhanced T1-weighted MR imaging, in addition to the hematoma, a definite vascular structure representing an AVM was seen (Fig. 1B). Vertebral angiography revealed that this was supplied by the right posterior cerebral artery and drained into the right transverse sinus (Figs. 1C, D).
Follow-up CT scan and angiogram four years later without further treatment.. A. Enhanced CT scan reveals marked regression, with a small residual AVM in the right occipital lobe and some encephalomalatic change at the site of the previous hematoma.. B. Right vertebral angiography shows complete disappearance of the AVM in the right occipital lobe.. C. Early-phase angiogram of the right external carotid artery depicts a residual AVM supplied by the right middle meningeal artery (arrows).. D. Late-phase angiogram of the right external carotid artery shows the same draining vein (arrow) seen at initial vertebral angiography, which drains into the right transverse sinus (arrowhead). The disappearance of the previous proximal portion of the draining vein seen in Fig. 1D suggests thrombus formation.. E. Photomicrograph (hematoxylin-eosin stain; magnification x100) depicts an AVM composed of abnormal vessels of various sizes and with fresh intraluminal thrombi (arrows).
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F2
AVM, with normalization of its feeder, the right posterior cerebral artery (Figs. 2A, B). A residual AVM was revealed by right external carotid angiography (Figs. 2C, D); during the delayed phase of this, the draining vein seen during previous vertebral angiography was opacified. The lesion was removed surgically and confirmed as an AVM with multiple thrombotic foci (Fig. 2E).