Ventricular arteriovenous malformation bleeding: a rare cause of headache in children. Case report

Abstract

-Headache as a chief complaint is rare in the paediatric emergency room.Actually, very seldom cases secondary to life threatening conditions as non-traumatic subarachnoid haemorrhage have been reported. A child with severe headache and nuchal rigidity and no other abnormalities on the physical examination is reported. Magnetic resonance angiography and cerebral angiography disclosed a ventricular arteriovenous malformation in the choroid plexus, supplied by the anterior choroidal artery, classified according to Spetzler grading system as grade 3 (deep venous drainage: 1; eloquence area: 0 and size: 2).The differences in the clinical presentations of the central nervous system arteriovenous malformation between children and adults are discussed.KEY WORDS: secondary headache in children, arteriovenous malformation of the brain, pediatric stroke. Hemorragia cerebral secundária a malformação artério-venosa ventricular: uma causa rara de cefaléia na infân-cia. Relato de casoRESUMO -Cefaléia como queixa principal raramente ocorre num serviço de emergência pediátrica. Quando isso acontece, casos de cefaléia secundária que trazem risco de vida, tais como a hemorragia subaracnóide são raramente relatados. Apresentamos o caso de uma criança que apresentou cefaléia de forte intensidade associada a rigidez de nuca, sem outras anormalidades no exame físico. A angioressonância e angiografia digital evidenciaram malformação arteriovenosa na topografia do plexo coróide do ventrículo lateral direito, nutrida pela artéria coroidéia anterior, grau III na classificação de Spetzler (drenagem venosa profunda: 1; área de eloqüência: 0 e tamanho: 2). Nós discutimos as diferenças na apresentação clínica das malformações arteriovenosas encefálicas nas crianças e adultos. PALAVRAS-CHAVE: cefaléia secundária, malformação arteriovenosa do encéfalo, malformação arteriovenosa ventricular.A headache due to a hemorrhagic stroke is a life-threatening clinical condition rarely seen in a paediatric emergency department 1,2 .When it occurs, an arteriovenous malformation should be ruled out. The arteriovenous malformation of the brain (AVM) accounts for 30% to 50% of such hemorrhagic strokes in children [3][4][5][6] and it has been associated with a 25% mortality rate 7 . On the other hand, the ventricular location is found in only 4% of the AVM in childhood 8 ; and in 1,3% of the adult's AVM 9 . We report a child with a history of sudden headache secondary to a bleeding of a ventricular arteriovenous malformation. CASEA 9-year-old previously healthy girl was admitted to the Emergency Room with an eight-hour history of sudden onset of severe headache. The pain was pulsatile and bilateral and not accompanied by other symptoms. There is no history of migraine, epilepsy or stroke. Parents reported that soon after the onset of the headache the patient

Headache Research and Medical Practice in Brazil: An Historical Overview

“…We will mention a few other Brazilians and the IHS member under whose supervision they studied or worked with: Luiz Paulo Queiroz/Alan M. Rapoport; Fernando Kowacs/Peter Goadsby; Mario Peres/Stephen Silberstein. Marcelo Eduardo Bigal started his training in headache medicine under the supervision of José Geraldo Speciali and Carlos Bordini, finalizing both MSc and PhD theses at Ribeirao Preto School of Medicine‐USP, and receiving postdoctoral training with Richard B. Lipton in New York.…”

“…Another important journal containing articles on headache written by Brazilians is Arquivos de Neuropsiquiatria, which was founded in 1945. 18,19,21,23,[41][42][43]52,81,[107][108][109][110]129,132,138,139,141,[147][148][149]153,158,[171][172][173] The Brazilian Headache Society created its own journal in 1983, entitled Migraneas & Cefaleias (ISSN1678-6270). In 2011, the Society decided to upgrade the journal in an attempt to enable it to become a truly international publication, accepting papers in English as well as in Portuguese.…”

“…A number of the early articles on headache disorders were published by Farias da Silva and coworkers in the scientific journal Neurobiologia (Recife), which is one of the oldest journals in the area of neurology in Latin America, founded in 1943 by Ulysses Pernambucano. Another important journal containing articles on headache written by Brazilians is Arquivos de Neuropsiquiatria , which was founded in 1945 …”

Intraventricular vascular malformations mimicking tumors: Case reports and review of the literature

“…To our knowledge, 34 intraventricular AVMs, including our two, have been reported [11][12][13][14][15][16][17][18] (Table 1). Intraventricular AVMs most frequently affected adults.…”