Radiology Case Presentation

David R. Beckert, MS-4

11/8/05

Case Background
Clinical History: 22 y.o. female presented
to Neuro angio for imaging of AVM, which
was discovered at OSH, in order to
proceed to interventional radiology for
gamma knife ablation procedure.

(Note: Unclear as to her original complaint that lead to the discovery of the AVM at the OSH)

Radiographic Images

Medium-sized AVM

Blood flow to AVM from internal carotid and vertebral

Distal venous stricture also noted

Arteriovenous malformations
Intracranial AVMs = 0.1% prevalence
(aneurysms =1.0%).
Supratentorial lesions = 90%
Posterior fossa = 10%
AVMs account for:
1 to 2 % of all strokes
3 % of strokes in young adults
9 % of subarachnoid hemorrhages

AVM Clinical Summary

AVMs usually present in the second to the
fourth decade of life.
Presentation:
Intracranial hemorrhage = 41-79 %
Seizures = 11-33 %
Headaches or progressive deficit
Younger patients (<30 yo) most often present
with seizures, while older patients more
commonly present with hemorrhage

AVM Imaging
Angiography is the gold standard for the diagnosis,
treatment planning, and follow-up after treatment
Anatomical and physiological information such as the
nidus configuration, its relationship to surrounding
vessels, and localization of the draining or efferent
portion of the AVM are readily obtained
Contrast transit times provide additional useful
information regarding the flow state of the lesion; this is
critical for endovascular treatment planning
AVMs typically first discovered via MRI/CT
MRI- very sensitive for location purposes and following
pts after treatment

AVM Grading Scale

AVM Treatment

Pt. Age is most important factor

Options include surgery, stereotactic radiosurgery, and
endovascular embolization
Stereotactic radiosurgery Stereotactically focused high energy
beams of photons or protons to a defined volume containing the
AVM nidus induces progressive thrombosis.
Time course usually one to three years, and the time between
treatment and obliteration is referred to as the latency period.
Once the lesion is completely obliterated, the hemorrhage risk from
the AVM is very low
Successful AVM obliteration with radiosurgery depends upon lesion
size and dose of radiation (complications also depend on
location/size of AVM and volume treated)

References
Singer, RJ, Ogilvy, CS, Rordorf, G.
Cerebral arteriovenous malformations.
UpToDate Online 13.3. February 25,
2005.
Spetzler, RF, Martin, NA. A proposed
grading system for arteriovenous
malformations. J Neurosurg 1986; 65:476.