There is evidence of multicentric AV angiomatous transformations (a variant of arteriovenous malformation) located in three separate areas.  The largest area of involvement is in the right posterior frontal centrum semiovale. The other two are small lesions: one is along the posterior pulvinar and the other is in the left lateral basifrontal cortex. A distinct nidus is absent in each lesion. Rather the afferent microfistula arteries appear dispersed within focal areas of brain parenchyma; the dilated efferent veins drain to either deep medullary venous system or to adjacent pial veins.

The largest site of the angiomatous AV transformation is located in the right mid, high convexity, frontal centrum semiovale. It is centered deep to the right premotor area, but not a usual eloquent site. This vascular lesion has diameter measures approximately 11 x 25 mm's. The afferent vessels arise from superior division MCA pial penetrating branches. The efferent vessels drain to the  to the pial veins; there is no deep medullary drainage. The AV shunt volume is low. There is no evidence of flow related aneurysms arising from the afferent parent arteries. There is no apparent evidence of efferent outflow stenosis. There is no evidence of venous aneurysms. The  Spetzler-Martin category is estimated at 1.  Angiomatous AV transformations, as in this case, represent focal-micro-AV-fistulae. This type of AV-shunting vascular malformation draws from pial and their penetrating vessels. They represent a variant of AVM without definable nidus, but with AV shunting that is less aggressive than either a direct AV fistulae or a typical AVM.

The second site of focal angiomatous AV transformation is located in the left basifrontal area. This vascular malformation draws from basifrontal pial vessels; it does not involve an eloquent site. This lesion has diameter measures approximately 8 mm's. The efferent vessels drain to local pial veins. The AV shunt volume is low. There is no evidence of flow related aneurysms arising from the afferent parent arteries, nor evidence of efferent outflow stenosis, nor evidence of venous aneurysms. The  Spetzler-Martin category is estimated at 1.

The third site of focal angiomatous AV transformation is located in the left mesial hippocampus/lateral geniculate nucleus area. This vascular malformation draws from the mesial PCA arteries. This lesion has diameter measures approximately 8-9 by 4 mm's. The efferent vessels drain to local pial veins flowing into the left BVR. There is no evidence of flow related aneurysms arising from the afferent parent arteries, nor evidence of efferent outflow stenosis, nor evidence of venous aneurysms. The AV shunt volume is low. The  Spetzler-Martin category is estimated at 1.