Subependymal vascular malformation with intraventricular hemorrhage
Presentation
Follow up of intraventricular hemorrhage after previous evacuation 2ry to subependymal vascular malformation.
Patient Data
An ill-defined tuft of vascular structure is seen involving the medial aspect of the high frontoparietal region. This tuft is converging down along the ependymal surface of the frontal horn of the lateral ventricle. The tuft is associated with a 2.5 mm enhancing rounded component at just subependymal location. This showed T2 hyperintensity and hypointense rim.
Intraventricular hemorrhage is seen in right lateral ventricle, with subacute blood products of T1 and T2 hyperintensity filling the frontal horn, body and occipital horn.
CT cerebral angiographgy
This vascular tuft is draining into ipsilateral deep veins, namely the caudate and septal veins. The ipsilateral dilated veins are prominent (thalamostriate, internal cerebral vein, MCV and BVR). The intra-ventricular hemorrhage is ill-defined on CT.
Left posterior parietal craniectomy defect is seen with tract of previous drainage shunt at left lateral ventricle.
Case Discussion
This case represents intra-ventricular subacute hemorrhage with underlying subependymal flow vascular malformation. Digital substraction angiography (DSA) is useful for more detailed arterial and venous connections to differentiate possible AVM from the less likely DVA.
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