Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
November 2016
Next Case of the Month coming December 6 …
Arteriovenous Malformation (AVM) with Intraparenchymal Hematoma
- Diagnosis:
- AVM is an arteriovenous shunting lesion without a capillary bed, composed of a prominent artery, a vascular nidus, and a dilated draining vein.
- Background:
- About 85% of the cases are supratentorial, while 15% are infratentorial.
- Epilepsy and intracerebral bleeding are the most common complications of AVM.
- Key Diagnostic Features:
- Spetzler-Martin classification (grades I–V) considers the location and size of the nidus, as well as venous drainage (deep or superficial).
- MRI shows intracranial hematoma with blooming on SWI and variable enhancement of AVM.
- MRA/MRV generally don’t reveal detailed angioarchitecture. Dynamic postcontrast MRA techniques can aid in the detection of shunting blood flow.
- DSA shows detailed angioarchitecture and possibilities of treatment (embolization of nidus).
- Differential Diagnosis:
- dural arteriovenous fistula, hypervascular tumors (hemangioblastoma, GBM)
- Treatment:
- embolization, microsurgery, radiosurgery
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