Co-existence of arterio-venous malformation and saccular bifurcation aneurysm of a 48years old patient, presented with massive intracranial hemorrhage: case report
- Journal of Neurology & Stroke
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Ayub Ansari, Asifur Rahman, NazminAhmed, ABM Manwar Hossain, Soumen Samadder, Mohammad Samsul Arifin, Robert Ahmed Khan, ASM Abu Obaida, Mohtasimul Hasan, Bipin Chaurasia
Abstract
Background: Hemodynamic aneurysm (HA) associated with arterio-venous malformation (AVM) is considered as one of the risk factors for intracranial hemorrhage.1,2 Aneurysm appears as a consequence of disruption in the cerebral auto regulatory mechanism which is induced by AVM. According to the previously reported literature, untreated HA after AVM exclusion can regress, remain unchanged, grow or rupture.1–4
Aim of the work: The aim of this case report is to describe a rare case of simultaneous presence of cortical arterio-venous malformation and saccular bifurcation aneurysm of a 48years old patient for which he underwent clipping of aneurysm and total excision of AVM in two sitting within very short interval of time and achieved favorable outcome.
Case report: A 48-year-old normotensive, non-diabetic male presented with sudden onset of severe headache followed by loss of consciousness. After thorough radiological evaluation, he diagnosed as a case of right sided MCA bifurcation aneurysm and small cortical parietal AVM. At first sitting, he underwent right sided pterional craniotomy and clipping of the aneurysm. 5days later he underwent right parietal craniotomy, evacuation of hematoma and total excision of AVM. His post-operative period was satisfactory and was released from hospital without having any neurological deficit.
Conclusion: Proper pre-operative work up, including angiogram should be done for any suspected vascular lesion. Considering the management of our reported case, Author recommends the simultaneous treatment of AVM and HA, which would be most beneficial to the patient.
Background: Hemodynamic aneurysm (HA) associated with arterio-venous malformation (AVM) is considered as one of the risk factors for intracranial hemorrhage.1,2 Aneurysm appears as a consequence of disruption in the cerebral auto regulatory mechanism which is induced by AVM. According to the previously reported literature, untreated HA after AVM exclusion can regress, remain unchanged, grow or rupture.1–4
Aim of the work: The aim of this case report is to describe a rare case of simultaneous presence of cortical arterio-venous malformation and saccular bifurcation aneurysm of a 48years old patient for which he underwent clipping of aneurysm and total excision of AVM in two sitting within very short interval of time and achieved favorable outcome.
Case report: A 48-year-old normotensive, non-diabetic male presented with sudden onset of severe headache followed by loss of consciousness. After thorough radiological evaluation, he diagnosed as a case of right sided MCA bifurcation aneurysm and small cortical parietal AVM. At first sitting, he underwent right sided pterional craniotomy and clipping of the aneurysm. 5days later he underwent right parietal craniotomy, evacuation of hematoma and total excision of AVM. His post-operative period was satisfactory and was released from hospital without having any neurological deficit.
Conclusion: Proper pre-operative work up, including angiogram should be done for any suspected vascular lesion. Considering the management of our reported case, Author recommends the simultaneous treatment of AVM and HA, which would be most beneficial to the patient.
Keywords
aneurysm, arterio-venous malformation, hemodynamic instability, AVM, arterio-venous malformation, CT, computed tomography, GCS, glasgow coma scale, HA, hemodynamic aneurysm, IEL, internal elastic lamina, MCA, middle cerebral artery, MRI, magnetic resonance imaging
