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
