Ultrafast rebleeding pediatric brain arteriovenous malformation: a case report

Brain arteriovenous malformation (bAVM) is the leading cause of intracranial haemorrhage in children, often resulting in severe morbidity and mortality. While both early and delayed interventions for ruptured bAVMs have advantages, the optimal timing remains controversial. We report an 11-year-old girl with a Spetzler-Martin grade III bAVM presenting with a distal flow-related aneurysm and mild altered consciousness. Six hours after the initial hemorrhage, she developed ultrafast rebleeding, necessitating emergency hematoma evacuation and subsequent staged embolization and resection. Despite total AVM removal, she suffered right hemiparalysis. This case highlights the potential for ultrafast rebleeding in pediatric bAVMs, particularly when distal flow-related aneurysms and altered consciousness are present. Early recognition and timely surgical intervention, including hemorrhage evacuation, should be considered to reduce the risk of catastrophic rebleeding and improve outcomes in this vulnerable population.