Recurrent Intraventricular Hemorrhages Caused by an AVM Detected by Angiography with Initially Normal Angiogram.

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Primary intraventricular haemorrhage (PIVH) is an uncommon non-traumatic cerebral bleed affecting adults and children, with varied causes.
• Vascular malformations, particularly arteriovenous malformations (AVMs), are a significant cause of PIVH in younger individuals.
• Clinical suspicion of PIVH includes sudden headache, nausea, vomiting, and altered consciousness.

Purpose of the Study:

• To report a rare case of isolated recurrent PIVH.
• To emphasize the importance of identifying underlying arteriovenous malformations (AVMs) in young patients with PIVH.
• To illustrate diagnostic challenges and the role of advanced imaging in detecting AVMs.

Main Methods:

• Cerebral computed tomography (CT) scan for initial PIVH confirmation.
• Magnetic resonance imaging (MRI) and catheter angiography for etiological investigation.
• Diagnostic intracranial angiography for definitive AVM detection in recurrent cases.

Main Results:

• The patient experienced isolated recurrent intraventricular haemorrhages.
• An underlying arteriovenous malformation (AVM) was identified as the cause of the recurrent hemorrhages.
• Initial angiography four years prior had failed to detect the AVM.

Conclusions:

• Recurrent PIVH in young patients warrants a high suspicion for underlying vascular lesions like AVMs.
• Repeated and advanced neuroimaging, including angiography, may be necessary to diagnose AVMs causing PIVH.
• Timely diagnosis and management of AVMs are crucial to prevent further hemorrhagic events.