Case report of a large, right, temporal arteriovenous malformation in the brain manifested by a progressive visual field defect

Abstract

AbstractPurpose: Emphasizing the importance of regular vision screening with visual fields and rapid MRI investigations where a field defect is unexplained. A 44 yo patient with a history of headache and incipient development of hemianopia gradually noticed bumping into things on the left‐hand side. In the last 6 months she also described 2 clear episodes of 5 min absence seizures, when she was staring into space. She has a history of iron deficiency being treated. Visual acuity was 6/6 corrected, right eye and 6/6‐2, corrected left eye. Normal pupillary reflexes. Visual fields showed gross left homonymous hemianopia. Optic discs showed no palor or cupping.Methods: Brain MRI showed a complex right temporal arteriovenous malformation (AVM) predominately supplied from the middle cerebral artery. There is a variceal dilation. There was some gliosis in the right temporal lobe suggesting previous bleed.Results: Urgent neurosurgeon assessment and catheter angiogram found a complex AVM which will likely be treated with gamma knife or embolization given patient age and previous evidence of bleed.Conclusions: This interesting case illustrates the importance of urgent imaging when faced with an abnormal visual field defect with no other underlying pathology.