• Geo-Seong Park and Jung-Soo Park.
• Department of Neurosurgery, Jeonbuk National University Hospital, Jeonju, Korea.
• Medicine (Baltimore). 2024 Jan 5; 103 (1): e36686e36686.

IntroductionPatients with cerebral arteriovenous malformation (AVM) have a lifetime risk of hemorrhagic stroke. Although identified asymptomatic cases can be monitored with imaging follow-up, treatment is considered in cases of AVM rupture or hemodynamic instability.Patient ConcernsA 43-year-old man who had been taking antihypertensive drugs for the past 5 years visited our hospital 3 days after the abrupt onset of headache. The patient also complained of progressive ptosis in the left eye.DiagnosesBrain computed tomography (CT) showed a small intraventricular hemorrhage with obstructive hydrocephalus. Subsequent brain CT angiography and magnetic resonance imaging confirmed the presence of an AVM in the cerebellar vermis.InterventionsEndovascular embolization was performed directly through the right femoral artery. Near-total obliteration of the AVM nidus was achieved by using multiple Onyx castings.OutcomesThe patient developed an altered mental status and right hemiparesis after the procedure. CT performed after the procedure revealed intraventricular hemorrhage in all ventricles, with a left thalamic intracerebral hemorrhage. Despite emergency external ventricular drainage and aggressive treatment for intracranial pressure control, the patient expired on the 14th day after the embolization procedure.LessonsWhen treating AVMs, especially those with a large nidus of high flow, it is necessary to consider possible hemorrhagic complications and preventive measures.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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