title: Hemorrhagic collision metastasis in a cerebral arteriovenous malformation.
abstract: A 26-year-old patient with recurrent choriocarcinoma of the testis presented with headache and progressive left homonymous hemianopsia. On initial MRI a grade 4 arteriovenous malformation (AVM) was identified in the right occipital lobe, which was further characterized by catheter angiography. Continued worsening of the headache in the following days prompted a follow-up MRI, which revealed a new T2 hypointense nodule and adjacent vasogenic edema in the periphery of the AVM. A follow-up MRI showed a marked increase in the size of the nodule with intrinsic enhancement and worsening perilesional edema. Based on the imaging evolution, the nodule was diagnosed as a metastasis and the patient was started on chemotherapy and radiotherapy. One week after the MRI he developed a sudden hemorrhage within the mass requiring decompression craniectomy and resection of both AVM and tumor. The histopathology of the resected mass confirmed the diagnosis of choriocarcinoma metastasis to the AVM.
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington, USA.
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Sundarakumar
authors.affiliation: Department of Pathology, University of Washington, Seattle, Washington, USA.
authors.forename: Desiree A
authors.initials: DA
authors.lastname: Marshall
authors.affiliation: Department of Pathology, University of Washington, Seattle, Washington, USA.
authors.forename: C Dirk
authors.initials: CD
authors.lastname: Keene
authors.affiliation: Department of Radiation Oncology and Neurological Surgery, University of Washington, Seattle, Washington, USA.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Rockhill
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Margolin
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D002822:Choriocarcinoma / Q000473:pathology*; D006261:Headache / Q000175:diagnosis / Q000209:etiology; D006423:Hemianopsia / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D009383:Neoplasms, Vascular Tissue / Q000150:complications / Q000175:diagnosis* / Q000556:secondary; D009778:Occipital Lobe / Q000473:pathology*; D013736:Testicular Neoplasms / Q000473:pathology*
keywords: Angiography; Arteriovenous Malformation; Hemorrhage; MRI; Metastatic