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Evaluation of a 23-year-old man with a history of tonic–clonic seizures revealed an arteriovenous malformation in the right parietal region of the brain (Panel A, arrow). Angiographic study of the internal carotid artery (Panel B, large arrow) delineated the malformation in the middle-cerebral-artery distribution, with draining veins (Panel B, small arrows) to the superior sagittal sinus. The patient underwent embolization followed by surgical resection, resulting in left hemiparesis. Three years later, the patient has weakness of his distal left arm but is functioning well and has no seizures.
Cerebral arteriovenous malformations are the result of secondary progressive dilatation of a congenital arteriovenous fistula. Most patients with arteriovenous malformations present in the first two decades of life. The most common signs and symptoms are hemorrhage and seizures.
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