Limitations of fetal ultrasonography and magnetic resonance imaging in prenatal diagnosis of congenital cerebral arteriovenous malformations with hemorrhagic onset

Case report

Seiichiro Eguchi M.D., Yasuo Aihara M.D., Ph.D., Kohji Yamaguchi M.D., Ph.D. and Yoshikazu Okada M.D., Ph.D.
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A fetus at 30 gestational weeks was observed on fetal ultrasonography to have a dilated right lateral ventricle. After delivery, the entity was diagnosed as a prenatal intracerebral hemorrhage (ICH) due to a ruptured arteriovenous malformation (AVM). Ultrasonography and MRI examinations performed before birth indicated a cerebral aneurysm in the territory of the right middle cerebral artery. However, digital subtraction angiography revealed an intracystic hemorrhage due to a ruptured cerebral AVM.

Arteriovenous malformations in children are rare, difficult to diagnose, and result in permanent sequelae after delayed treatment. Patient prognosis depends on early and accurate diagnosis and intervention. Outcomes can be improved if an AVM in a child is detected at the onset of ICH for young infants in the prenatal or early postnatal periods. Early AVM diagnosis is limited to fetal ultrasonography and MRI, and special consideration through invasive examination including neonatal digital subtraction angiography is urged unless a correct and clear diagnosis is made at an early stage. Prenatal ICH due to an AVM is rare. The authors discuss their observations and findings.

Abbreviations used in this paper:AVM = arteriovenous malformation; CTA = CT angiography; DSA = digital subtraction angiography; ICH = intracerebral hemorrhage; MCA = middle cerebral artery; MRA = MR angiography.

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Contributor Notes

Address correspondence to: Yasuo Aihara, M.D., Ph.D., Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. email: yaihara@nij.twmu.ac.jp.

Please include this information when citing this paper: published online June 22, 2012; DOI: 10.3171/2012.4.PEDS11517.

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