Neurosurgery

Fig. 20.3. Case 3: A 42-year-old Broadway producer began to experience paroxysms of speech hesitancy. An MRI revealed a left temporal lobe vascular malformation. The patient was started on anticonvulsants and a cerebral angiogram was performed. a AP view of an early arterial phase left internal carotid cerebral angiogram demonstrated a 2-cm middle temporal gyrus AVM. The inferior temporal branch of the middle cerebral artery supplied the AVM. The venous drainage was superficial and no aneurysms were noted. b Lateral view of a mid-arterial phase left internal carotid cerebral angiogram illustrated the AVM nidus and two superficial cortical-draining veins entering the transverse sinus. Early opacification of the AVM's venous drainage during the arterial phases of a cerebral angiogram was characteristic for this type of malformation. Venous ectasia of the proximal draining veins was present. This AVM was classified as a Spetzler—Martin Grade 2 (1 for size, 1 for eloquence (receptive speech area) and 0 for deep venous drainage). This patient opted for pre-operative NBCA embolization, followed by microsurgical excision.

Fig. 20.3. Case 3: A 42-year-old Broadway producer began to experience paroxysms of speech hesitancy. An MRI revealed a left temporal lobe vascular malformation. The patient was started on anticonvulsants and a cerebral angiogram was performed. a AP view of an early arterial phase left internal carotid cerebral angiogram demonstrated a 2-cm middle temporal gyrus AVM. The inferior temporal branch of the middle cerebral artery supplied the AVM. The venous drainage was superficial and no aneurysms were noted. b Lateral view of a mid-arterial phase left internal carotid cerebral angiogram illustrated the AVM nidus and two superficial cortical-draining veins entering the transverse sinus. Early opacification of the AVM's venous drainage during the arterial phases of a cerebral angiogram was characteristic for this type of malformation. Venous ectasia of the proximal draining veins was present. This AVM was classified as a Spetzler—Martin Grade 2 (1 for size, 1 for eloquence (receptive speech area) and 0 for deep venous drainage). This patient opted for pre-operative NBCA embolization, followed by microsurgical excision.

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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