Images in Clinical Medicine

Kim Eagle, M.D., Editor

Cerebral Arteriovenous Malformation

Kathleen Lee, M.D., and B. Leonard Holman, M.D.

N Engl J Med 1995; 332:923April 6, 1995

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Article

Figure 1 Magnetic resonance imaging and angiography of the brain revealed a left parietal arteriovenous malformation measuring 2.5 cm in diameter in a 32-year-old woman who presented with severe headache. Panel A, a coronal T₁-weighted magnetic resonance image, and Panel B, an axial T₂-weighted magnetic resonance image, demonstrate a tangle of abnormal vascular channels. Rapid blood flow causes a lack of signal intensity within the larger vessels of the arteriovenous malformation. Interspersed areas of higher signal intensity within the nidus of the arteriovenous malformation may represent regions of slow blood flow or hemorrhage (arrow, Panel A). An enlarged subependymal draining vein extends into the left lateral ventricle (arrow, Panel B), and an enlarged cortical draining vein is visible. As seen on the magnetic resonance angiogram (Panel C), the arteriovenous malformation (black arrow) is fed predominantly by the left middle cerebral artery (white arrow). There is also an aneurysm (2 to 3 mm) of the left middle cerebral artery proximal to its bifurcation. Cerebral angiography confirms the presence of the arteriovenous malformation (arrow, Panel D). The patient received stereotactic radiation therapy and is currently asymptomatic. R denotes right, and L left.

Kim Eagle, M.D.

Kathleen Lee, M.D.
B. Leonard Holman, M.D.
Brigham and Women's Hospital, Boston, MA 02115