De novo cerebral arteriovenous malformation: Pink Floyd's song "Brick in the Wall" as a warning sign.
BACKGROUND
Arteriovenous malformations are shunts between an artery and the venous system that lie within a nidus without an intervening capillary bed. These lesions are thought to be congenital, but recent reports have challenged this assumption.


METHODS
A 50-year-old man presented to the emergency department with a generalized tonic-clonic seizure. Before the onset of his seizure, he experienced a vivid auditory hallucination of his favorite song by the band Pink Floyd, "A Brick in the Wall." He had been diagnosed with epilepsy 25 years previously. On presentation, his neurological examination was normal, but a computed tomography scan of the brain revealed a large arteriovenous malformation (AVM) occupying the left temporal lobe. Upon more detailed questioning, he recalled that a brain angiogram had been performed 25 years before and was reported to be normal. Neurosurgery was not performed in view of the size of the malformation. The patient is being followed-up as an outpatient.


CONCLUSIONS
AVMs may arise de novo and then spontaneously become symptomatic. Cerebral de novo AVM should be considered in the differential diagnosis in patients with complex auditory musical hallucinations or any new neuropsychiatric symptoms.
Ozsarac
Murat
M
Department of Emergency Medicine, Ege University Hospital, Izmir, Turkey.
Aksay
Ersin
E
Kiyan
Selahattin
S
Unek
Orkun
O
Gulec
F Feray
FF
D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging*; D004827:Epilepsy / Q000150:complications; D006212:Hallucinations / Q000209:etiology*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012640:Seizures / Q000209:etiology*