Open AccessManagement of a ruptured and unruptured pial arteriovenous fistula during and after pregnancy
Author(s) -
Clayton H. Gerndt,
Dylan J. Goodrich,
Dinesh Ramanathan,
Brian C Dahlin,
Ben Waldau
Publication year - 2021
Publication title -
brain circulation
Language(s) - English
Resource type - Journals
eISSN - 2455-4626
pISSN - 2394-8108
DOI - 10.4103/bc.bc_37_20
Subject(s) - medicine , surgery , arteriovenous fistula , fistula , embolization , headaches , hematoma
We present the case of a 16-week pregnant 19-year-old female who presented with hemiplegia due to a ruptured right frontal pial arteriovenous fistula (PAVF). She was also found to have an unruptured right temporal PAVF and a family history of brain hemorrhage. The patient was managed with Onyx embolization of the ruptured fistula, followed by surgical excision and hematoma evacuation. At 35 weeks gestation, she underwent cesarean section to prevent rupture of the second fistula in the setting of peripartum hypervolemia and increasing headaches. The child was delivered healthy. Subsequently, the right temporal AV fistula, supplied by a middle cerebral artery and posterior cerebral artery branch, underwent staged embolization resulting in complete occlusion. The patient recovered to a modified Rankin score of two, with a left foot drop as only persistent significant motor deficit.