Classic Left Tempro-parietal Arteriovenous Malformations

Case History: A 28-year-old man presented with history of pulsing noise in the head and progressive right hemiparesis. 

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Figure 1

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Figure 2

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Figure 3

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Figure 4

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Figure 5

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Figure 6

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Figure 7

Findings: Axial, coronal MR T2-WIs images and axial post-contrast MR T1-WI image show multiple flow voids and tubular structures lesion that involves the left tempro-parietal regions . The normal brain parenchyma is interspersed between the abnormal vessels no significant contrast enhancement detected. MRA shows enlarged arteries and draining veins, A-V shunting with early venous filling.

Diagnosis: Classic left tempro-parietal arteriovenous malformations

Discussion: Vascular lesions of the brain are uncommon lesions that may pose a diagnostic challenge due to their similar clinical manifestations and imaging features. Different classification systems have been put forward. The most commonly used classification system separates vascular lesions into arteriovenous malformations (AVMs), which may be either pial or dural, depending on the location of the shunt; cavernous hemangiomas (or cavernomas); capillary telangiectasia; and developmental venous anomalies (DVAs, formerly known as venous angiomas) (1–3).

However, from a clinical, imaging, and prognostic standpoint, further subclassification of various diseases that were formerly subsumed under the heading “brain AVMs” seems necessary . MRA offers several advantages over conventional angiography. For example, because of its ability to image all vessels in a given volume, an AVM with multiple feeding arteries can be imaged noninvasively in a single study. In addition, 2-dimensional (2D) and 3-dimensional (3D) phase-contrast MRA can be used to examine the direction, rate, and quantity of blood flow. Another advantage of MRA is the ability to retrospectively examine images in any plane. (4–6).

References:
1. Chaloupka JC, Huddle DC. Classification of vascular malformations of the central nervous system. Neuroimaging Clin N Am 1998;8(2):295–321.
2. Wagner BJ, Richardson KJ, Moran AM, Carrier DA. Intracranial vascular malformations. Semin Ultrasound CT MR 1995;16(3):253–268.
3. Zabramski JM, Henn JS, Coons S. Pathology of cerebral vascular malformations. Neurosurg Clin N Am 1999;10(3):395–410.
4. Lasjaunias PL, Landrieu P, Rodesch G, et al. Cerebral proliferative angiopathy: clinical and angiographic description of an entity different from cerebral AVMs. Stroke 2008;39(3):878–885.
5. Hoh BL, Putman CM, Budzik RF,Ogilvy CS. Surgical and endovascular flow disconnection of intracranial pial single-channel arteriovenous fistulae. Neurosurgery 2001;49(6):1351–1363; discussion 1363–1364.
6. Lasjaunias P, Manelfe C, Chiu M. Angiographic architecture of intracranial vascular malformations and fistulas: pretherapeutic aspects. Neurosurg Rev 1986;9(4):253–263.

Doaa Ibrahim, MD in radio-diagnosis, Zagazig University Hospitals and TechnoScan Centers in Egypt