Presentation
Seizure, aphasia and headache.
Patient Data
A round mass of serpiginous flow voids giving a bag of worm appearance is seen in the left inferior frontal gyrus (nidus measuring about 3.6 x 3.7 cm). The nidus is compact. No significant intervening brain tissue is noted.
The lesion involves Broca's motor speech area and is supplied by branches of the left MCA which are mildly prominent.
The exiting vein is draining into the superior sagittal sinus. The draining vein is mildly dilated (maximum- 10mm). After contrast administration the lesion shows serpiginous vessel-like enhancement. The lesion shows facilitated diffusion.
Impression- Arteriovenous malformation.
Feeding artery - branches of left MCA. Draining vein - superior sagittal sinus.
Case Discussion
Arteriovenous malformation is a high flow vascular malformation which consists of a nidus, feeding artery and draining vein.
The Spetzler-Martin grading system can be used to predict the post surgical mortality and morbidity risk.
In this case :
size of the nidus (3.7 cm) - 1 point
eloquence of adjacent brain (Broca's area) - 1 point
venous drainage (superficial) - 0 point
Thus, the above case is Grade II AVM.
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