Arteriovenous Malformations

The Migraine And Headache Program

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Fig. 20.4. Case 4: A 65-year-old female presented with sudden headache, confusion and trace right-sided weakness. a An urgent axial head CT scan revealed a left-sided parietal hyperdensity. b An axial T1-weighted non-contrast MRI through the area of abnormality revealed a 2-cm cavernous malformation with areas of hemorrhage of various chronicity. An acute intraparenchymal bleed was noted anterior to the lesion. The woman was brought to the operating room and the lesion was removed. c A postoperative axial Tl-weighted non-contrast MRI confirmed the successful resection of her cavernous malformation. With a brief period of rehabilitation, the patient returned to her usual state of good health.

Fig. 20.4. Case 4: A 65-year-old female presented with sudden headache, confusion and trace right-sided weakness. a An urgent axial head CT scan revealed a left-sided parietal hyperdensity. b An axial T1-weighted non-contrast MRI through the area of abnormality revealed a 2-cm cavernous malformation with areas of hemorrhage of various chronicity. An acute intraparenchymal bleed was noted anterior to the lesion. The woman was brought to the operating room and the lesion was removed. c A postoperative axial Tl-weighted non-contrast MRI confirmed the successful resection of her cavernous malformation. With a brief period of rehabilitation, the patient returned to her usual state of good health.

Fig. 20.5. Case 5: A 69-year-old woman with new-onset headaches received an MRI, revealing a cerebellar vascular malformation. Lateral view of a venous phase left vertebral artery cerebral angiogram revealed a centripetal venous cluster in the right cerebellar hemisphere, which drained into a dilated pre-central cerebellar vein that subsequently emptied into the straight sinus. These angiographic features are typical of a DVA. The patient's headaches were medically managed.

the brain or in the posterior fossa infrequently cause seizures, whereas frontal-lobe AVMs may cause generalized seizures, motor strip AVMs may cause Jacksonian seizures and medial temporal lobe AVMs are often associated with complex partial seizures [6]. Most AVM-related seizures respond well to anti-epileptic medication. However, some AVMs, particularly in the medial temporal lobe, may cause medically refractory epilepsy. AVM resection may reduce the frequency of seizures, or completely eliminate the seizure disorder in a small percentage of patients [6].

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