Recurrent spontaneous cervical hemorrhage in a patient with neurofibromatosis type 1 requiring repeated endovascular...

Neurofibromatosis type 1 (NF1) is a genetic disorder occasionally associated with vascular abnormalities, including arterial fragility and spontaneous rupture. Cervical hemorrhage related to NF1 is rare, yet potentially life-threatening, and its management presents significant challenges. Here, the authors report a rare case of NF1 complicated by recurrent spontaneous cervical hemorrhage requiring repeated endovascular embolization.

A 67-year-old man with NF1 presented with acute cervical swelling without a history of trauma. CT revealed a large cervical hematoma causing tracheal deviation, and CT angiography showed active extravasation from a branch of the thyrocervical artery. Emergency endovascular embolization using n-butyl-2-cyanoacrylate achieved hemostasis. The following day, recurrent hemorrhage developed from branches of the transverse cervical and internal thoracic arteries, necessitating repeat endovascular embolization. After the second intervention, no further bleeding occurred, and the patient recovered with supportive care.

In patients with NF1, cervical hemorrhage may recur early from a vascular territory distinct from the initially treated lesion. Even after a technically successful embolization, close early surveillance is required. https://thejns.org/doi/10.3171/CASE26354.