Ruptured Arteriovenous Malformation Anterior to the Brainstem to a Child with Subsequent Spontaneous Thrombosis: Case Report and Literature Review

Abstract

Unusual clinical course Background:Cerebral arteriovenous malformations (AVMs) are considered to be abnormalities of congenital origin, presumably arising due to a disorder in the process of embryogenesis, in the phase of differentiation of premature vascular domes into mature arteries, capillaries, and veins. The end result of that process is the formation of direct arteriovenous communications, without intervening capillary beds. Case Report:We report the case of a 6-year-old female who suffered an abrupt deterioration of her level of consciousness due to a subarachnoid hemorrhage located in the basal cisterns. Radiological investigation with magnetic resonance arteriography-magnetic resonance venography (MRA-MRV) was negative, but digital subtraction angiography (DSA) revealed a micro-AVM in the vicinity of the brainstem. The patient subsequently developed communicating hydrocephalus and the repeat DSA, performed 1 month later, failed to re-imagine the lesion. Further workup with DSA 1 year after the ictus was negative for pathological findings. Conclusions:There are a lot of controversies regarding the optimal imaging modality for surveillance of pediatric AVMs, the time period needed to follow-up a given lesion, even if it is considered treated, and the underlying mechanism of spontaneous thrombosis of untreated, yet ruptured, AVMs. All these issues, along with the unusual mode of evolution of the clinical picture of this lesion are discussed in detail, along with a review of the available literature.

Unveiling the domino effect: a nine-year follow-up on pentalogy of central nervous system induced by a large unruptured cerebral arteriovenous malformation: a case report and literature review

“…This form accounts for 94.4% of such presentations, characterized by moderate to severe hydrocephalus and representing approximately 72% of all identified mechanisms ( 3 , 11 ). Secondly, chronic venous hypertension from impaired drainage can hinder the reabsorption of cerebrospinal fluid (CSF), usually leading to communicating hydrocephalus ( 15 ). This is observed in almost all cases, where the hydrocephalus is primarily mild to moderate, constituting about 28% of the mechanisms ( 7 , 16 ).…”

Sudden death caused by ruptured brain arteriovenous malformation in an adolescent with autism spectrum disorder

“…Other reported symptoms include confusion, fluctuating emotions, memory impairment, sensory abnormalities, headaches, and seizures. Children presenting to medical care with bAVMs (9,10) are more likely than adults to have hemorrhagic lesions (11), and their symptoms may overlap those seen in autism spectrum disorders (8). Although supratentorial bAVMs are commoner, those in the posterior fossa are more dangerous, as they are more likely to rupture.…”