Improbable discovery of an incidental high-grade AVM: illustrative case

Document Type

Journal Article

Publication Date

4-28-2025

Journal

Journal of neurosurgery. Case lessons

Volume

9

Issue

17

DOI

10.3171/CASE24850

Keywords

cerebral arteriovenous malformation; incidental finding; nail gun injury; penetrating traumatic brain injury

Abstract

BACKGROUND: The authors discuss the first reported case of a large, high-grade arteriovenous malformation (AVM) in the dominant hemisphere, discovered incidentally after a penetrating nail gun injury. OBSERVATIONS: The patient underwent surgical removal of a nail lodged in the right frontal lobe. A contralateral AVM was diagnosed on his perioperative imaging and was evaluated further with diagnostic cerebral angiography. Because of the location of the AVM within the dominant fronto-opercular region, the patient underwent a super-selective Wada test to evaluate for the risk of expressive language deficit prior to undergoing a successful resection of the AVM. He had an excellent recovery from both surgeries without any neurological deficits. LESSONS: This case illustrates the importance of continued suspicion for incidental findings when reviewing imaging, despite the presence of a known and obvious pathology. The observations add nuance to the standard considerations for surgical intervention for penetrating nail gun injuries, and the workup for incidentally found vascular lesions is reviewed. https://thejns.org/doi/10.3171/CASE24850.

Department

School of Medicine and Health Sciences Resident Works

Link to Full Text

Share

COinS