Higher cortical disorders: an unusual presentation of an arteriovenous malformation

The authors present a patient with a large arteriovenous malformation in the temperoparietooccipital region of the dominant hemisphere that caused seizures, a homonymous hemianopia, and broad neuropsychological disturbances probably caused by a cerebral steal syndrome. There was no history of hemorrhage. Surgical resection resulted in marked improvement of neuropsychological function and disappearance of the hemianopia. The authors discuss the pre- and postoperative neuropsychological findings, the pathogenesis of the steal phenomenon, and the indications concerning the resection of this large and deep-seated arteriovenous malformation in a functionally important region of the left hemisphere. They state that surgical resection is the method of choice.