Presentation
Residual left hemiparesis with persistent headache.
Patient Data
A poorly defined, slightly hyper-dense area in the right temporal region, containing localized calcifications as well as serpingous-like structures. In addition, there are surrounding areas of hypo-densities suggestive of gliosis with ex vacuo dilatation of the respective ventricle.
Moderate-sized arteriovenous malformation in the right temporal region with a nidus measuring 3.6 x 2.6 cm with localized proliferation of multiple vessels. This process represents a classical "bag of worms" appearance. There are feeding arteries from the right MCA distribution most likely from M2 branches whilst draining veins from the veins of Rosenthal and Galen into the right internal cerebral vein. There are also veins draining into the right transverse and superior sagittal sinuses.
This arteriovenous malformation was graded as a Spetzler-Martin IV.
3D Reconstruction of AVM demonstrating vessels in detail.
Case Discussion
This case represents a classical cerebral arteriovenous malformation with a Spetzler-Martin Grade IV based on the medium size, area of non-eloquence, and deep venous drainage.
On a non-contrasted scan, the rounded calcification could be mistaken for an old granuloma by an untrained eye. In this case, the calcifications within the vessel walls along with the surrounding infarct helped to narrow the differential. On a contrasted scan, the diagnosis becomes certain.
Case courtesy of Dr Ignatious Tshegofatso Menyatsoe.
3D reconstruction courtesy of Genevie Moodley.
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