Vascular Imaging of the Head and Neck – Case C
This case is the third of four cases that go with the vascular capstone course. On that page, there is a scrollable case that you can go through to teach you how to approach a CTA of the head in a real patient.
This case is a 43 year-old woman with seizure. Take a look and see what you think before continuing on ( https://bit.ly/CTAcaseC).
On the noncontrast CT, you see some high density material in the right frontal lobe. It is more dense than contrast, which is consistent with calcium. If you look more closely at the morphology, it is almost curvilinear or tubular, giving the impression that it might be calcification along vascular structures. The sulci of the frontal lobe are effaced with masslike effect on the brain.
While the diagnosis is uncertain, there are enough features to make us think that there is an underlying vascular malformation. To check, we need to do some sort of vascular imaging. The most readily available and fastest is to do a CT angiogram.
On the CT angiogram, the proximal vessels are normal, but the abnormalities start at the proximal middle cerebral artery (MCA) and anterior cerebral artery (ACA) on the right. There are too many vessels in this region and they are too tortuous. If you follow them up, they go to a large and tortuous vascular abnormality in the right frontal lobe.There are enlarged draining veins that empty into the superior sagittal sinus.
This is the classic imaging appearance of arteriovenous malformation (AVM) within the brain. AVMs are congenital vascular abnormalities that consist of an abnormal connection of arteries and veins with a tangle of abnormal vessels, the nidus. Go on and look at the volume rendered (VR) reconstruction and the coronal maximum intensity projection (MIP) images to better understand what this abnormality looks like.
Once you’ve finished this video, I recommend going back to the vascular capstone course, where you can review the other browseable cases with explanations. The capstone overview is here , if you’d like to see all the cases and videos.
Or, see all of the vascular capstone videos in the vascular imaging capstone playlist.