Dural AVM associated with Cryptic Vascular Malformation presenting as an Intracerebral Hematoma

Case Report

Abstract

Occurrence of multiple intracranial arteriovenous malformations (AVM) in one patient is extremely rare. A 72-year-old woman was admitted with a sudden onset of severe headache, vomiting, right hemiparesis, lethargy, and motor aphasia. Computerized tomography (CT) scan showed a small left temporal subcortical hematoma. Angiography revealed a dural AVM near the left lateral dural sinus, fed by the left occipital and left posterior auricular arteries. The left lateral sinus was seen occluded, and the venous drainage consisted of the vein of Labbe and the left sphenoparietal sinus. Three weeks later, the patient gradually became comatose, and repeat CT scan showed enlargement of the hematoma, surrounded by a low-density area. Emergency evacuation of the hematoma was performed. A small mass easily prone to bleeding was found on the wall of the hematoma cavity. Microscopic examination revealed cryptic vascular malformation.
The mechanism of intracerebral hemorrhage in this patient was noteworthy. Rupture of the cryptic vascular malformation was the cause of the hematoma. Highly elevated venous pressure alone can cause such a rupture. The elevated venous pressure in the left temporal lobe was the result of retrograde flow via the vein of Labbe and the ipsilateral transverse sinus occlusion.