Female, 77 years old, with aphasia and right-sided weakness. Findings are seen compatible with a very large AV malformation involving the left posterior frontal, parietal, and perhaps temporal lobes. This includes numerous convoluted and serpentine flow voids, several of which are markedly dilated. The left MCA vessels are generally enlarged indicating the likely primary source of supply. Numerous dilated draining veins are noted including surface veins which drain to the dural venous sinuses and veins which drain to the deep system. Accounting for differences in technique, the overall morphology and size of the lesion seem to be unchanged relative to prior CTs.No restricted diffusion is seen. No definite evidence of parenchymal edema is seen. Mild T2 hyperintensity within the AVM may represent gliosis. The lesion does cause generalized left cerebral mass effect with effacement of sulci, partial effacement of the left lateral ventricle, and a relatively mild 5 mm midline shift to the right. These findings do not appear to have changed significantly. Within the lesion, there is a 10 mm T1 hyperintense lobule which could represent a small hemorrhagic collection or perhaps a thrombosed vascular channel.
Findings are seen compatible with a large left sided AV malformation involving the posterior frontal lobe, parietal lobe and perhaps a small portion of the temporal lobe. The overall size of the lesion does not seem to have changed significantly. It appears that the left MCA serves as a major source of supply for the lesion with venous drainage to both superficial and deep systems. The degree of associated mass effect does not appear to have changed. No definite acute abnormalities are seen.