Clinical Neuroscience

Single-hole, ruptured parenchymal arteriovenous fistula of the mesencephalon: not known vascular malformation of the brain or a posthemorrhagic entity?

KULCSÁR Zsolt1,2, MACHI Paolo2, VARGAS Isabel Maria2, SCHALLER Karl3, LOVBLAD Olof Karl2

MARCH 30, 2021

Clinical Neuroscience - 2021;74(03-04)


Case Reports

The subtypes of brain arteriovenous malformations, with direct, single-hole fistulas without co-existing nidus are not described as existing entities inside the brain parenchyma but on the pial surface. True parenchymal arteriovenous malformations present with nidal structure, even if they are small, whereas surface lesions may present a direct fistulous configuration. In this case of midbrain haemorrhage a direct arteriovenous fistula was detected at the level of the red nucleus between a paramedian midbrain perforator artery and a paramedian parenchymal vein, with pseudo-aneurysm formation at the fistulous connection, without signs of adjacent nidus structure. The hypothesis whether a pre-existing arteriovenous fistula ruptured or a spontaneous haemorrhage has caused the fistulous connection is discussed.


  1. Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
  2. Neuroradiology Division, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
  3. Neurosurgery Division, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland



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