Other malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: vein of Galen malformation History: poor perfusion Brain MRI:Very limited exam, only non contrast enhanced T1 sagittal scans were obtained.There is large signal void at the vein of Galen area with tubular structure connecting the lesion to the distal superior sagittal sinus.There is no evidence of abnormal signal intensity of the brain.Ventricle size remains normal size and symmetric.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate enlarged bilateral vertebral arteries and PCAs. Bilateral PCAs are fetal origin.In particular there are multiple vascular in flow signal on the right side of ambient cistern indicating increased vascularity. The left side distal PCA branch appears to show more direct communication with the large aneurysmal pouch indicating direct arteriovenous shunting. The aneurysmal pouch shows relatively stenotic outlet especially transverse direction, but the craniocaudal direction appears to be non-stenotic.There is no evidence of intracranial arterial aneurysm or stenosis.
1. Arteriovenous shunting drains through an aneurysmal pouch which connects to inferior aspect of superior sagittal sinus, most likely diagnosis is vein of Galen malformation draining through persistent median prosencephalic vein.2. No evidence of abnormal signal intensity of brain although limited exam.3. Normal appearance and size of ventricular system. 