Prenatal ultrasound diagnosis of cerebral arteriovenous fistula

Background: We describe a case of arteriovenous fistula of the middle and posterior cerebral arteries detected in a fetus. Case: Fetal echocardiography revealed a high-output cardiac failure. Color Doppler ultrasound demonstrated an arteriovenous fistula, localized at the middle and posterior cerebral arteries, which drained in a large venous aneurysm occupying the posterior fossa. The aneurysm caused cerebellar dislocation and temporal lobe hypoplasia. Necropsy after pregnancy termination confirmed the ultrasound findings. Conclusion: This case demonstrates that malformation of a fetal cerebral artery can lead to brain hypoplasia and thus to severe mental handicap. This possibility needs to be considered in patient counseling.