title: Vein of Galen arteriovenous malformation mimicking coarctation of the aorta.
abstract: Arteriovenous malformation of the vein of Galen is a rare congenital intracranial anomaly lacking a capillary bed and subsequent aneurysmal enlargement of the arterial and venous system, warranting careful management due to associated morbidity and mortality. Coarctations of aorta demonstrate similar neonatal echocardiographic signs to the vein of Galen arterial malformation (VGAM). We present a boy at 37 weeks of gestation whose initial ultrasound and echocardiographic investigations showed a dominant right ventricle and isthmal hypoplasia, suggestive of coarctation of aorta. Follow-up ultrasound and echocardiography revealed an arteriovenous malformation involving middle and posterior cerebral artery branches, eliminating coarctation of aorta. VGAM was confirmed by further ultrasound and angiographic investigation, which demonstrated a tangle of cerebral and choroidal arterial branches centrally feeding into an enlarged vein of Galen. The boy's hemodynamic and neurological statuses were confirmed to be stable despite increased venous pressure. Elective embolization at 7 months of age was complicated by a cerebrovascular accident, resulting in right hemiparesis despite no residual cardiac issues. This case demonstrates that rarely, arteriovenous malformations such as the vein of Galen malformations may be the primary cause of patients presenting with coarctation of aorta. The rarity of this condition and its guarded prognosis make our case of special interest to cardiologists and the perinatal care team.
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, ON Canada ; Bachelor of Health Sciences (B.H.Sc. Honours) Program, McMaster University, 4077 Tea Garden Circle, Mississauga, ON L5B 2W5 Canada.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Firdouse
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, ON Canada ; Bachelor of Health Sciences (B.H.Sc. Honours) Program, McMaster University, 252 Macedonia Crescent, Mississauga, ON L5B 3R7 Canada.
authors.forename: Arnav
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Pediatrics, McMaster Children's Hospital, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada.
authors.forename: Tapas
authors.initials: T
authors.lastname: Mondal
keywords: Cerebral arteriovenous malformation; Coarctation of aorta; Isthmal hypoplasia; Vein of Galen