Abstract

Objective: Bilateral arteriovenous malformations (AVMs) are clinically rare except in hereditary autosomal disease. There is conflicting evidence on the incidence and severity of cognitive symptoms in non-hemorrhagic AVMs. The relationship between a patient's cognitive profile and the size and location of multiple AVMs was explored in this case study. Method: A 20-year-old white female with new onset seizures during her second trimester of pregnancy was diagnosed with non-familial, bilateral, temporal AVMs. Prior history included depression, headaches, and attentional problems. Following successful delivery of child, the patient completed a clinical interview and a standard comprehensive battery of tests assessing learning, memory, language, executive, spatial, and fine motor functioning. Presenting complaints included memory, concentration, and word-finding difficulties in the context of headaches. Imaging documented an AVM in the left temporal, lateral, cortical region at the superior and middle temporal gyri measuring 3.5cm, and a second AVM in the right hippocampus measuring 1.5 cm. Results: Testing documented mild working memory (CVLT, Trial 1 = 5/16), fluency (phonemic T = 39), and naming difficulties (BNT T = 38), as well as right-sided weakness (Grip T = 33). Spatial, attention, and visual memory skills were intact (T ≥ 43). Conclusion(s): Lateralizing findings were consistent with the size and location of the AVMs. Results of the present study suggest that non-ruptured AVM may result in cognitive deficits as a function of not just to location, but of AVM size. Neuropsychological data was used to plan initial surgical intervention around the left sided AVM, thus. Thus, neuropsychological examination may aid in surgical treatment planning.