title: Pial arteriovenous fistulas associated with multiple aneurysms presenting as intracerebral hemorrhage: a case report.
abstract: Intracranial pial arteriovenous fistulas (AVFs) associated with multiple aneurysms of the main feeding arteries are very rare cerebrovascular lesions. We report a unique case of pial AVFs associated with four aneurysms of the feeding anterior cerebral artery (ACA) which presented as intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH) and spontaneous subarachnoid hemorrhage (SAH). CT angiography (CTA) and digital subtraction angiography (DSA) images demonstrated clearly the direct connection without nidus between the first and second segment of right ACA accompanied by four irregular aneurysms and an abnormally dilated draining vein into the superior sagittal sinus (SSS). Owing to the superficial-seated fistulas, the morphology of feeding arteries and associated four aneurysms and intracranial hemorrhage, the lesions were surgically treated. Postoperative cerebral angiography certified closure of the fistulas and exclusion of the four aneurysms as well as disappearance of early venous drainage. However, subsequent precontrast brain CT showed hydrocephalus underwent left ventriculoperitoneal shunt placement.
authors.affiliation: Second Affiliated Hospital of Soochow University, Department of Radiology, Suzhou, P.R. China.
authors.forename: Wu
authors.initials: W
authors.lastname: Cai
authors.forename: Jianping
authors.initials: J
authors.lastname: Gong
authors.forename: Bochao
authors.initials: B
authors.lastname: Cheng
authors.forename: Fang
authors.initials: F
authors.lastname: Qiao
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhu
authors.forename: Qing
authors.initials: Q
authors.lastname: Lan
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000002:abnormalities*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002550:Cerebral Veins / Q000002:abnormalities*; D003937:Diagnosis, Differential; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male