A young woman with a first-time seizure and a huge intracranial vascular structure

Abstract

A 27-year-old woman presented with a first-time seizure. MRI of the head showed a large, 7 cm, round vascular structure inside the right lateral ventricle with mass-effect (figure A). Simultaneous right carotid and vertebral angiography (figure B and video 1) showed a direct high-flow arteriovenous shunt (figure B, arrow) between the right posterior cerebral artery and a grossly dilated subependymal ventricular vein. An aneurysm on the supraclinoid internal carotid artery was also seen (figure B, arrowhead).