The

n e w e ng l a n d j o u r na l

of

m e dic i n e

images in clinical medicine Lindsey R. Baden, M.D., Editor

Intracranial Arteriovenous Malformation A

C

B

Amadeo R. Rodriguez, M.D. Ramiro Larrazabal, M.D. McMaster University Hamilton, ON, Canada [email protected]

A 

28-year-old man with a childhood history of spontaneous intracranial hemorrhage presented with a new onset of seizures and loss of consciousness. At the age of 10 years, he had undergone partial resection of a right-sided intracranial arteriovenous malformation, which resulted in left hemiplegia. He was completely blind in the right eye, and visual acuity in the left eye was 20/20 with a temporal hemianopic field defect. Computed tomography without contrast material revealed a new acute intraparenchymal hemorrhage (Panel A, arrow) adjacent to an area of encephalomalacia (Panel A, arrowhead) on the right. Angiography showed a residual arteriovenous malformation (Panel B, black arrow), with an additional intracranial arteriovenous malformation located in the inferior aspect of the anterior cranial fossa (Panel B, blue arrow) to the right of the midline, which was fed by branches of the ophthalmic artery and right inferolateral trunk (Panel B, arrowhead). Ophthalmoscopic examination revealed a retinal arteriovenous malformation in the right eye (Panel C), whereas the left eye was normal. The patient underwent surgical correction of the intracranial arteriovenous malformation. At follow-up 10 months later, his vision remained unchanged. He had persistent left hemiplegia and was continuing to receive antiseizure medication.

DOI: 10.1056/NEJMicm1313525 Copyright © 2015 Massachusetts Medical Society.

e4

n engl j med 372;3 nejm.org january 15, 2015

The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF SUSSEX on January 15, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.