Growth of Occult Arteriovenous Malformation After Cerebral Hemorrhage Demonstrated by Serial Magnetic Resonance Imaging Case Report

• Published in: Neurologia medico-chirurgica Vol. 41; no. 2; pp. 83 - 86
• Main Authors: FUSE, Takahisa, NIWA, Yuji, UMEZU, Masanari, YAMADA, Kazuo
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 2001
• Subjects: Adult; Cerebral Angiography; cerebral hemorrhage; Cerebral Hemorrhage - diagnosis; Cerebral Hemorrhage - pathology; Cerebral Hemorrhage - surgery; Follow-Up Studies; Humans; Intracranial Arteriovenous Malformations - diagnosis; Intracranial Arteriovenous Malformations - pathology; Intracranial Arteriovenous Malformations - surgery; Magnetic Resonance Imaging; Male; Middle Cerebral Artery - abnormalities; Middle Cerebral Artery - pathology; Middle Cerebral Artery - surgery; occult arteriovenous malformation; Postoperative Complications - diagnosis; Postoperative Complications - pathology; Postoperative Complications - surgery; Recurrence; Reoperation; vascular endothelial growth factor
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.41.83

A 19-year-old male presented with sudden onset of right hemiparesis caused by left cerebral hemorrhage. Cerebral angiography demonstrated no vascular abnormality, and the hematoma was removed surgically. At operation, no abnormal vascular lesion was found in the brain adjoining the hematoma. Two years later, magnetic resonance (MR) imaging demonstrated a few foci of flow voids adjacent to the hematoma cavity. Four years after the hemorrhage, MR imaging showed more extensive flow-void abnormalities that indicated growth of an occult arteriovenous malformation (AVM). Cerebral angiography indicated a definite AVM supplied mainly by branches of the middle cerebral artery. Total resection of this lesion was performed. The histological diagnosis was typical AVM. Immunohistochemistry with vascular endothelial growth factor showed staining in the walls of the abnormal vessels. Serial MR imaging is very useful for the diagnosis and management of occult AVMs.