• Yuhei Michiwaki, Akira Nakamizo, Yosuke Kawano, and Tomoyuki Tsumoto.
• Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan. Electronic address: wayside.bamboo@gmail.com.
• World Neurosurg. 2019 Apr 1; 124: 454745-47.

BackgroundWhether the risk of rupture of a cerebral arteriovenous malformation (AVM) increases during pregnancy remains controversial. Moreover, it is unclear whether the number of pregnancies correlates with AVM rupture risk. We report a case of ruptured AVM during the fifth pregnancy.Case DescriptionA 34-year-old woman presenting sudden headache and vomiting was admitted to our hospital. Neuroimaging revealed a subarachnoid hemorrhage due to a ruptured AVM in the right temporal lobe. She was pregnant (9 weeks and 1 day), and she had previously experienced 4 normal vaginal deliveries (gravidity and parity G4P4) without complications. Elective treatment including neuroendovascular and direct surgery was performed, and the AVM was safely resected (at 15 weeks, 6 days of pregnancy). She underwent elective caesarean section without complications 151 days after the AVM resection (at 37 weeks, 1 day of pregnancy), and the baby was healthy.ConclusionsThis report suggests that the risk of AVM rupture persists even after multiple deliveries. Intracranial hemorrhage should be suspected in pregnant patients who underwent multiple deliveries, and a rapid diagnosis and appropriate treatment are necessary.Copyright © 2018. Published by Elsevier Inc.

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