A gentleman aged 38
years presented with a 5 years history of a feeling off epigastric discomfort
followed by automatic movements lasting for 10 minutes followed by complete
recovery. He had no memory of the episode. He was diagnosed as a case of complex
partial seizures which were poorly controlled with medication.
CT scan of the head
showed a lesion in the right temporal lobe of the brain(yellow arrows).
MRI brain also revealed
an Arterio-venous malformation in the right temporal lobe(yellow arrows)
Digital Subtraction Angiography
showed that the malformation was fed by branches from the middle cerebral
artery with veins draining towards the surface and into the depth.
The AV malformation
was completely removed by microsurgical technique. During surgery multiple
tortuous arterialized veins were fed by right first part of the middle cerebral
artery. It was drained by two veins, one over the brain surface and the other
towards its lower surface.
Post-operative CT
scan of head showed surgical changes and the cavity left after removal of the AVM
(yellow dots)
The patient recovered
well and was discharged intact on long term anti-epileptic medication.
