Abstract Details

A mixed pial-dural AVM is defined as receiving blood supply by cerebral/cerebellar arteries (pial) as well as from meningeal arteries (dural). Dural AVM’s are usually acquired (i.e. venous thrombosis) but pial AVM’s are considered congenital. An AVF is an anomalous connection between the arterial and venous circulation surrounding the brain or spinal cord. These two anomalies combined have not been reported in the literature to our knowledge

57-year-old woman without past medical history presented to the Neuro-Interventional clinic after a left cerebellar hemorrhage.  Two months prior to presentation, she had an episode of severe vertigo, headache described as the worst of her life, neck rigidity and vomiting. She was taken to the nearest hospital where she was diagnosed with a cerebellar hemorrhage secondary to an AVM Spetzler-Martin Grade I. Hospitalization was complicated by hydrocephalus requiring an extra-ventricular drain (EVD), which caused a right parietal hemorrhage.  An angiogram performed at our facility revealed a left cerebellar hemisphere mixed pial AVM and dural AVF. The nidus measured 7 mm in diameter fed by hypertrophied branches of the left anterior-inferior cerebellar artery. The venous drainage was to the left cerebellar veins, into the left petrosal vein and into the left transverse sinus. The draining veins of the AVM connected to the draining vein of the left petrosal dural AVF fed by proximal branches of the left middle meningeal artery.

To our knowledge this is the first case reported of a mixed pial-dural AVM combined with an AVF. Failure to recognize that both the AVM and AVF have the same drainage, can lead to embolization of the AVF vein leading to increase pressure in the AVM causing it to rupture.