Not all patients with a headache need a CT scan, but they should be listened to, and also with a stethoscope: a report of a large arteriovenous malformation with a loud cranial bruit
  • Thomas Matthews
    Department of Medicine, Tipperary University Hospital, Clonmel, Ireland
  • Noah Salzberg
    Department of Medicine, Tipperary University Hospital, Clonmel, Ireland
  • Trisheekeshan Thayeswaran
    Department of Medicine, Tipperary University Hospital, Clonmel, Ireland
  • Nikhil Jacobs
    Department of Medicine, Tipperary University Hospital, Clonmel, Ireland
  • Niall S. Colwell
    Department of Medicine, Tipperary University Hospital, Clonmel, Ireland

Keywords

Arteriovenous malformation, Martin-Spetzler, epilepsy, cranial bruit, homonymous hemianopia

Abstract

Background: Arteriovenous malformations (AVMs) are abnormal direct connections between arterial and venous systems, without an interposed capillary bed. This permits high-flow arteriovenous shunting, which precipitates structural changes in the afferent and efferent vessels, namely arterial smooth muscle hyperplasia and thinning of venous walls. Patients with intracranial AVMs typically present with a haemorrhage, headache or seizure. Treatment is either via medical management aimed at control of seizures, headache and blood pressure, or interventional via surgical, radiation or radiologically guided embolisation.
Case description: We report the case of a woman in her early 40s presenting with a tonic-clonic seizure against a background of a 31-year history of migraine and an 18-month history of tremors in her right arm. The clinical examination was remarkable for an extremely loud cranial bruit and a right homonymous hemianopia. Imaging diagnosed an 8 cm Martin-Spetzler grade V intracranial arteriovenous malformation in her left parietal lobe, which was deemed unsuitable for operative or radiotherapy-based intervention.
Conclusion: The patient was managed through observation and relatively good control of her breakthrough seizures was achieved through the addition of brivaracetam to her lamotrigine and carbamazepine-based therapy, six years after her initial presentation.

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    Published: 2024-07-02
    Issue: 2024: LATEST ONLINE (view)

    How to cite:
    1.
    Matthews T, Salzberg N, Thayeswaran T, Jacobs N, Colwell NS. Not all patients with a headache need a CT scan, but they should be listened to, and also with a stethoscope: a report of a large arteriovenous malformation with a loud cranial bruit. EJCRIM 2024;11 doi:10.12890/2024_004669.

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