An interesting case of Arterio venous malformation

HISTORY

40 year old lady, receptionist by profession Had 1 episode of sensory seizure 2 months

ago. She was unable to wash her hand after lunch

and collapsed. Found to have low BP Rest for 1 week and then resumed work

Patient felt very weak Took leave from work 2 weeks after resuming

work Taken to nearby hospital MRI brain plain – LEFT FRONTAL AVM. Dilation of

the left MCA and ACA. No hemorrhage seen. Referred here for furthur management

Examination

Conscious, alert Systemic examination – no abnormality CNS- no cranial nerve deficit

no motor or sensory deficit

no neck rigidity, DTR -2+

plantars - flexor bilaterally

cerebellar system – normal

gait and stance - normal

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MRI BRAIN• Tuft of vessels in

the left frontal region.

• Extra-axial

• Dilation of ACA and MCA branches

• No thrombosis

• No hemorrhage

• Subtle gliosis along the margins

Cerebral angiogram

Large left frontal AVM• Nidus measuring approximately 5cm. Feeders

off left A3 segment of left ACA and M3 segment of left MCA

• No aneurysm seen in relation to the feeding arteries or intranidal

• No intranidal arterio-venous fistula or venous pouch

• Drainage into the superior sagittal sinus, cavernous sinus and the left transverse sinus

• The lesion also fills via the right ICA and both vertebral artery injection.

MANAGEMENT -

POST OPERATIVE CT

After the procedure she could lift her hands and also smile