Cerebral Arteriovenous Malformation in Pregnancy

Abstract

Background: Cerebral arteriovenous malformations (CAVMs) are rare congenital lesions but the life-threatening condition with the possibility of rupturing during pregnancy. Case description: The case was a 25-year-old primigravida at 17 weeks gestation who was presented with recurrent prolonged excessive vomiting for a 1-month duration and treated as hyperemesis gravidarum. Subsequently, she had right hemiparesis and it was preceded by throbbing headache. The clinical diagnosis of paradoxical emboli or ruptured CAVM is made based on the clinical findings. Magnetic resonance imaging (MRI) brain showed subacute bleeding of ruptured AVM at the left parietal region. Angiogram revealed the site of bleeding vessels for excision of AVM and helped to arrest the bleeding. The benefit of surgery was outweighing the risk of miscarriage and proceeded with craniotomy, evacuation of hematoma, and excision of AVM at 22 weeks of gestation. Her postoperative course was uneventful and there was no issue of teratogenicity as a fetus at 24 weeks gestation. She had delivered a baby boy 2.8 kg via elective cesarean section at 38 weeks gestation without maternal and fetal complications. Conclusion: Cerebral arteriovenous malformations are relatively uncommon lesions in the general population and rare among pregnant females with significant maternal and fetal morbidity and mortality. The various clinical presentations warrant the different management approaches. Hence, a multidisciplinary team approach tailored to the individual case with appropriate management should be employed for pregnant women with CAVMs regardless of clinical presentation at gestational age and risk of rupture during pregnancy.