An Unusual Case of Cerebral Arteriovenous Malformation in Pregnancy

Abstract

We present a case of a woman at 31 weeks and 3 days of gestation, who developed a sudden and severe headache and loss of vision in her left eye. Magnetic resonance imaging (MRI) of the brain revealed a subarachnoid bleed secondary to a right parieto-occipital arteriovenous malformation (AVM). She was conservatively managed and subsequently transferred to our institution for multidisciplinary care. The patient underwent a cesarean section at 34 weeks and 5 days of gestation followed by gamma knife surgery 6 days after. Cerebral AVMs, although relatively rare, have the propensity to cause potentially fatal outcomes. Neurological symptoms in a pregnant woman warrant investigations for early diagnosis and management, due to its associated morbidity and mortality. The management of cerebral AVMs in pregnancy is decided after weighing the benefits of treatment against the risk of bleeding. A multidisciplinary approach should be adopted due to the complexity of the condition.

Keywords: AVM; Cerebral arteriovenous malformation; Obstetrics; Pregnancy.

Figure 1

Axial (a) and coronal (b) MRI of the brain performed at our institution demonstrated a nidal type right parietal AVM (as shown by arrows). MRI: magnetic resonance imaging; AVM: arteriovenous malformation.

Figure 2

CT of the brain performed in view of patient’s persistent worsening headache revealed no acute intracranial hemorrhage or large territorial infarct. A few foci of isodensity with foci of calcifications (arrow) were seen in the right parietal lobe, associated with adjacent gliosis, and likely related to underlying vascular malformation. CT: computed tomography.