Sunday, 21 June 2015

AVM with bleed and ischemic complications on MRI

Clinical Details  : Two months ago suffered from a left basal ganglionic bleed. Had to have decompression done. PResently has a power of grade 0 on the right arm and right leg but speech is fairly well preserved. 
Presently on Ecosprin gold, Omnacortil. Pantocard.

Advised MRI for better evaluation

video

MRI Brain with MR Angiography of Brain Report

Sequences planned are FLAIR, T2w*GRE and DW images.
Non Contrast Enhanced intracranial Angio performed with 3D TOF and Neck Angio performed with 2D TOF sequence. The study viewed in row as well as 3D reconstructed images.

A focal Gliosis  with hemosiderin staining on GRE involving left thalamus, adjacent basal ganglia, insula and temporal lobe_ Chronic resolved hematoma with areas of chronic ischemic infarcts in left MCA cortical branches territory. 
An associated changes of distal wallerian degeneration on left side. 
An obvious high flow vascular malformation _ AVM noted, left pcom appears to be the feeder. 
Sparisty of cortical branches of left MCA. 

Rest of the both intra cranial as well as extra cranial vessels show normal flow related signals on 3D reconstructed images of Non Enhanced 3D TOF and 2D TOF sequences.

Impression: 

Chronic resolved hematoma with chronic infarcts in left MCA cortical branches territory.
An obvious high flow vascular malformation / AVM noted, left pcom appears to be the feeder. 
Sparisty of cortical branches of left MCA compared to right.

Needs DSA for better evaluation / confirmation. 

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