Presentation
Headaches.
Patient Data
There is a large left cerebral hemispheric AVM, predominantly frontal, but also involving the left insula and opercula. The nidus is difficult to measure confidently, but measures of least by 5.5 cm. Predominantly left MCA, feeders with the M1 and M2 dilated in a fusiform pattern (5 mm M2 MCA). Further left MCA lenticulostriate, ACA and PCA feeders. No overt feeding arterial saccular aneurysms. There is a fusiform aneurysmal draining vein in the sylvian fissure (17 mm), with enlarged superior and inferior anastomotic and cortical veins draining into the sagittal left transverse sinus. The left basal vein is also enlarged. There is surrounding FLAIR hyperintensity and volume loss, suggesting surrounding gliosis. No convincing blood products to suggest previous hemorrhage.
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