Treatment of arteriovenous malformations associated with ruptured intracranial aneurysm

Abstract

Spontaneous subarachnoid hemorrhage (SAH) is a specific characteristic of aneurysmal rupture. SAH coexisting with arteriovenous malformations is challenging to treat because the patient status at admission is severe and the therapeutic approach is multidisciplinary: endovascular treatment, cerebral fluid drainage, and decompressive craniectomy. We report a clinical case successfully treated for cerebellar hemorrhage due to a ruptured aneurysm with arteriovenous malformations. A 65-year-old woman was admitted to Can Tho SIS General Hospital within six hours of stroke onset. She experienced loss of consciousness, aphasia, and high blood pressure. Non-contrast computed tomography showed a diffused SAH in both cerebellum hemispheres, Sylvian fissure, intraventricular hemorrhage, and non-communicating hydrocephalus. Her medical history included uncontrolled hypertension. The patient underwent multidisciplinary treatment for hydrocephalus, cerebellar edema, and embolization to control recurrent ruptured arteriovenous malformations. She recovered well and was discharged on day 30 with a Modified Rankin Scale score of 1.