The new england journal of medicine images in clinical medicine Hemispheric Arteriovenous Malformation A B valuation of a 23-year-old man with a history of tonic–clon- John Mark Vermillion, M.D. ic seizures revealed an arteriovenous malformation in the right parietal re- F.S. Harris, M.D. gion of the brain (Panel A, arrow). Angiographic study of the internal carotid Texas A&M Health Science Center artery (Panel B, large arrow) delineated the malformation in the middle-cerebral-artery Temple, TX 76508 distribution, with draining veins (Panel B, small arrows) to the superior sagittal sinus. The patient underwent embolization followed by surgical resection, resulting in left hemiparesis. Three years later, the patient has weakness of his distal left arm but is functioning well and has no seizures. Cerebral arteriovenous malformations are the result of secondary progressive dilatation of a congenital arteriovenous fistula. Most patients with arteriovenous malformations present in the first two decades of life. The most common signs and symptoms are hemorrhage and seizures. e Copyright © 2004 Massachusetts Medical Society. n engl j med 350;17 www.nejm.org april 22, 2004 The New England Journal of Medicine Downloaded from nejm.org at NEW YORK MEDICAL COLLEGE on August 11, 2015. For personal use only. No other uses without permission. Copyright © 2004 Massachusetts Medical Society. All rights reserved. e15