Presentation
Poorly responsive. Headache and right-sided weakness. On examination, the Glasgow Coma Score was 10/15 and reduced power right leg.
Patient Data
Intraparenchymal bleeding in the left frontoparietal region with associated vasogenic edema. In close proximity to the bleed, multiple calcified vessels can be seen in the left parietal cortex near the vertex likely representative of a clump of arteriovenous malformation.
Large cerebral arteriovenous malformation with its nidus in the left frontoparietal region. The left anterior cerebral artery is disproportionately large tracing to its pericallosal branch. This is felt to be the feeding artery. Multiple dilated draining cortical veins of Trolard can be appreciated draining to the dilated superior sagittal sinus. A number of other dilated draining sinuses are seen including left thalamostriate vein, internal cerebral vein and vein of Gallen.
There is a number of incidental aneurysms including two basilar artery saccular aneurysms.
Case Discussion
Classic supratentorial cerebral arteriovenous malformation causing a large intraparenchymal cerebral bleed in a young patient.
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