Concluded Case

RUPTURED AVM

40yrs old male patient admitted with a Sudden severe headache associated with nausea and vomitting.H/o - Fever n cough three days before.Patent only physical exam finding was Right hemiparesis otherwise he was conscious with GCS - E4V5M5,Pupils - B/l 4mm RTL.APPROACH?

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Concluded answer
MR Angio report
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It's an AVM in the left MCA territory. The angiography pictures could have been more clear to characterise the lesion. Seems to be having 2 feeders from the image. There is one arterialised draining vein possibly draining into superior sagittal sinus.. We need better images in the venous phase to identify the draining vein more clearly. Considering the size and superficial location it will be comfortably accessible surgically. Endovascular option can be considered, but my preferred option for management: surgical. But considering the AVM to be in MCA territory that too on the left side ( which is the dominant side in more than 60% of the population) we need to explain clearly the possibility of motor deficits and speech defects ( which could be predicted more clearly with better angiography pictures)
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Case of acute onset of headache with upper respiratory tract infection. We must know drug history? What is blood pressure on admission? Mri brain -left parietal -cortical hemorrhage Mri angio- left Middle cerebral artery with cortical venous sinus connection Possibility of- Dural AV malformation Other possibility Intra nidus aneurysm Ideally needs to do( gold standard) DIGITAL SUBSTRACTION ANGIOGRAPHY :- to rule out additional extracranial connection with AVM TREATMENT 1)anti-edema measure 2) Analgesic 3) Dsa followed by Embolisation vs coiling (depends on finding) Blood pressure monitoring and strictly controlled Pls note that decongestant like specific pseudoephedrine increasing blood pressure.
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This is a case of AVM with mass effect and significant hematoma, the MRA reports and scans prove the same. Suggest to take advise from NSX and manage symptomatically until further instructions from NSX
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AVM BLEED left temporal withdrawing vessels to up sagittal sinus
Rewriting the answer. AVM LEFT TEMPORAL WITH BLEEDING AND THE FEEDER IS DRAINIG TO SUPERIOR SAGITTAL SINUS . Suggest .REF Interventional Radiologist.
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