• R Salvesen and K A Hugaas.
• Nevrologisk avdeling, Nordland Sentralsykehus, Bodø.
• Tidsskr. Nor. Laegeforen. 2000 Apr 30; 120 (11): 1304-6.

BackgroundPatients known to harbour a cerebral arteriovenous malformation that is inaccessible to therapy may have a second bleeding into the subarachnoid space, but from another source.Material And MethodsTwo patients had previously bled from an intracranial arteriovenous malformation; both were considered inaccessible to surgical or endovascular repair. The patients were then admitted to hospital with symptoms and signs suggesting a second subarachnoid haemorrhage.ResultsDiagnostic work-up demonstrated an aneurysm as the probable source of haemorrhage in both patients.InterpretationPatients harbouring an intracranial arteriovenous malformation are much more likely to develop an associated intracranial aneurysm than patients without such malformations, and a second bleeding in these patients will more often arise from the associated aneurysm. The cause of the frequent association of an aneurysm is probably haemodynamic stress due to the increased blood flow through the feeding artery. These patients suffer subarachnoid haemorrhage more often than patients with either an aneurysm or a malformation alone. The therapeutic strategy should be carefully individualized and the aneurysm should more often have priority.

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