Cerebral arteriovenous malformation

Discussion:

Cerebral AVMs are graded according to Spetzler Martin classification, which grades the size of the nidus, the location of the lesion in the brain (eloquent vs non-eloquent area) and venous drainage.

The patient had a CT scan for longstanding headache (<10 years), with no apparent neurological deficits at the time of the study. It was the first radiology study ever ordered to the patient. This incidental imaging finding demonstrates the importance of imaging in headache. CT is the modality of choice in emergency settings, however MRI scans can provide us much more detailed information in the majority of cases.

In this case with no apparent neurological deficit and with no bleeding, the question remains the same: should this lesion be treated or not? should we wait until it bleeds or performs treatment because of the headache? (the patient is not asymptomatic, she refers longstanding pain).

Treatment options include endovascular embolization and radiosurgery. 

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