Pediatric Intracranial Arteriovenous Malformation

  • Etiology: Vascular malformation
  • Imaging CT When Ruptured:
    — Hemorrhagic stroke with subarachnoid hemorrhage
    — Periventricular hematoma with extension to ventricles
  • Imaging MRA:
    — Enlarged arteries
    — Nidus
    — Draining vein
  • DDX:
  • Complications: 3% rupture rate per year (cumulative)
  • Treatment:
  • Clinical:
    — Common cause of spontaneous intracranial hemorrhage and hemorrhagic stroke in children
    — Risk of hemorrhage with intracranial AVM is about 2% per year

Radiology Cases of Intracranial Arteriovenous Malformation

MRI and MRA and US of intracranial arteriovenous malformation
Axial T2 MRI of the brain (above left) shows large vascular flow voids representing the nidus of the lesion along the right hemisphere of the brain and a dilated sagittal sinus. Sagittal US of the midline of the brain (above right) shows a large vascular structure with mixed arterial and venous flow within it that is compressing and displacing the sagittal sinus beneath it. MR angiogram with contrast of the brain (below left) shows a large nidus of arterial vessels along the right cerebral hemisphere fed primarily by the right middle cerebral artery that rapidly drain into a dilated sagittal sinus on the MR venogram (below right).