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Case Reports
. 2012 Oct;7(4):210-3.
doi: 10.4103/1793-5482.106657.

Traumatic epidural and subdural hematomas and extensive brain infarcts in a patient with pial arteriovenous malformation: Mechanisms underlying clinical and radiological findings

Venkatesh S Madhugiri  1 , Arivazhagan Arimappamagan, Bangalore A Chandramouli
Affiliations
Case Reports

Traumatic epidural and subdural hematomas and extensive brain infarcts in a patient with pial arteriovenous malformation: Mechanisms underlying clinical and radiological findings

Venkatesh S Madhugiri et al. Asian J Neurosurg. 2012 Oct.

Abstract

We report a rare case of a patient with a pial arteriovenous malformation (AVM) who presented in altered sensorium. He was found to have large epidural and subdural hematomas overlying a pial AVM. He underwent evacuation of these hematomas and postop computed tomography showed infarcts deep to the site of hematoma evacuation. These infarcts were postulated to be due to a steal phenomenon combined with raised intracranial pressure. The management and possible mechanisms for this rare combination are discussed.

Keywords: Arteriovenous malformation; epidural hematoma; infarcts; steal phenomenon; subdural hematoma.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Preop plain computed tomography axial image showing a thick left frontoparietal acute subdural hematoma. (b) Preop plain computed tomography axial image showing a left temporoparietal epidural hematoma. (c) Bone windows showing a left temporal linear fracture. (d) Intraop photo showing a lax brain after epidural hematoma and subdural hematomaevacuation and a grossly arterialized Sylvian vein
Figure 2
Figure 2
(a) Postop contrast-enhanced CT showing resolution of midline shift, persisting edema. There are multiple deep temporal infarcts with a small area of hemorrhage in one of the infarcts (arrow). (b) computed tomography showing infarcts in the left middle cerebral artery and anterior cerebral artery territory
Figure 3
Figure 3
(a) Contrast-enhanced CT showing an enhancing nidus in the left frontal area. (b) Digital subtraction angiogram showing the arteriovenous malformation fed by branches of the anterior cerebral artery and middle cerebral artery
See this image and copyright information in PMC

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