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Letter

Comment on “Aneurysms Associated with Brain Arteriovenous Malformations”

F. Clarençon, E. Shotar and N.-A. Sourour
American Journal of Neuroradiology January 2017, 38 (1) E1-E4; DOI: https://doi.org/10.3174/ajnr.A4966
F. Clarençon
aDepartment of Interventional Neuroradiology Pitié-Salpêtrière Hospital AP-HP Paris, France
bParis VI University (Pierre et Marie Curie University) Paris, France
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E. Shotar
aDepartment of Interventional Neuroradiology Pitié-Salpêtrière Hospital AP-HP Paris, France
bParis VI University (Pierre et Marie Curie University) Paris, France
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N.-A. Sourour
cDepartment of Interventional Neuroradiology Pitié-Salpêtrière Hospital AP-HP Paris, France
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    Fig 1.

    A, Unenhanced brain CT scan (axial section) in a 40-year-old woman with headache. Right occipital hematoma is seen (white arrow). Note a round hypoattenuated shape surrounded by the hematoma, corresponding to the intranidal aneurysm (black arrow). B, Volume rendering reconstruction from the 3D-RA acquisition through the left vertebral artery, showing a large intranidal aneurysm (white arrow). C and D, Left vertebral DSA in anteroposterior projection at early phase (C) and late phase (D). At early phase, an intranidal aneurysm is seen (C, arrow). On late phase, this nidal aneurysm appears clearly connected to the main draining vein (D, arrowheads), confirming the venous nature of this intranidal aneurysm.

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    Fig 2.

    A and B, Left vertebral artery DSA in lateral projection in a 41-year-old woman with a ruptured right parieto-occipital bAVM. A, Early phase showing a nidal aneurysm (black arrow) before filling of the draining vein. B, Intermediate phase showing a second intranidal aneurysm (white arrow) in addition to the first one (black arrow). Note a focal venous ectasia on the main draining vein (white dotted arrow). C and D, Selective DSA in anteroposterior projection from the parieto-occipital branch of the right posterior cerebral artery through a flow-dependent microcatheter. C, Early phase showing the filling of both the nidus and an intranidal aneurysm before any venous filling. D, Intermediate phase showing, in addition to the previously described intranidal aneurysm (black arrow), a second smaller nidal aneurysm (double arrow) close to the origin of the main draining vein (arrowheads). Note the presence of a focal venous ectasia on the main draining vein (black dotted arrow).

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    Fig 3.

    A, Unenhanced brain CT scan (axial section) showing a left parieto-occipital hematoma associated with intraventricular hemorrhage in a 19-year-old woman. B and C, Brain CT angiography: axial section (B) and sagittal reconstruction (C). Small false aneurysm arising from the nidus and close to the hematoma is seen on both axial and sagittal images (B and C, white arrows). The close relationship between the intranidal aneurysm and the hematoma suggests the aneurysm as being the cause of the bleeding. D–F, Left vertebral artery DSA in lateral projection at very early phase (D), early phase (E), and intermediate phase (F). At very early phase, opacification of the nidus is seen, supplied mainly by the left posterolateral choroidal artery (D, black arrowheads). Note the opacification of an intranidal aneurysm located at the posterior aspect of the nidus (D, white arrow) before any substantial filling of the venous drainage. At later phase, the origin of the draining vein is filling (E, white arrowheads) while the nidal aneurysm is still visible (E, white arrow). On intermediate phase, stagnation of the nidal aneurysm is seen (F, white arrow) while the venous drainage is more clearly seen (F, white arrowheads).

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American Journal of Neuroradiology: 38 (1)
American Journal of Neuroradiology
Vol. 38, Issue 1
1 Jan 2017
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F. Clarençon, E. Shotar, N.-A. Sourour
Comment on “Aneurysms Associated with Brain Arteriovenous Malformations”
American Journal of Neuroradiology Jan 2017, 38 (1) E1-E4; DOI: 10.3174/ajnr.A4966

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Comment on “Aneurysms Associated with Brain Arteriovenous Malformations”
F. Clarençon, E. Shotar, N.-A. Sourour
American Journal of Neuroradiology Jan 2017, 38 (1) E1-E4; DOI: 10.3174/ajnr.A4966
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