Presentation
Sudden loss of consciousness while playing football.
Patient Data
On non-contrast CT there is intraparenchymal hematoma in left frontal lobe of the brain, surrounded by small area of perifocal edema, with insignificant mass effect.
No intraventricular hemorrhage. No sign of hydocephalus.
No signs of skull fracture.
CT angiography
CTA shows an arteriovenous malformation in the posterior part of hematoma. Feeding artery is a branch of left MCA. Draining veins: cortical vein that drains into superior sagittal sinus and branch of left internal cerebral vein. No sign of active contrast extravasation.
Case Discussion
Lobar hematoma with absense of traumatic agent and skull fracture (especially in pediatric population) should be suspicious for arteriovenous malformation bleeding. CTA of the brain is the best modality for AVM detection.
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