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Tailored Cognitive Testing with Provocative Amobarbital Injection Preceding AVM Embolization

Lauren R. Mooa, Kieran J. Murphyb, Philippe Gailloudb, Mark Tesoroa and John Harta

a Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD
b Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD



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  		FIG 1. An example of a non-real object: In this case, a pot with the outline of a trumpet is where the handle is expected.



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  		FIG 2. DSA images in a 27-year-old woman with a left supratentorial AVM.

A, Initial diagnostic angiogram of the left common carotid artery, lateral view, shows a large AVM nidus in the left perirolandic region. Multiple arterial feeders arise from the superior and inferior division of the left MCA. Note the early opacification of the three dilated veins draining into the superior sagittal sinus.

B, During the third embolization session, the tip of the flow-directed microcatheter is advanced into a feeder that topographically corresponds to the anterior parietal branch of the left MCA. Superselective angiogram obtained prior to possible embolization shows opacification of a discrete portion of the nidus and an enlarged parietal vein, but it shows no evidence of normal arterial structures or parenchymal blushing. The amobarbital test is performed with the microcatheter tip in this position.

C, After the documentation of cognitive deficits that correlate with the left parietal cortex during the amobarbital test, the microcatheter is repositioned to a slightly more distal location, and a another superselective angiographic study is performed. This second angiogram clearly reveals the presence of two previously undetected arterial branches with a normal appearance that arise from the large feeder; these are responsible for parenchymal blushing.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X