Cerebral intraventricular hemorrhage caused by a large cerebral arteriovenous malformation at 31 years after diagnosis.

Cerebral arteriovenous malformation (AVM) has an overall 2% to 4% annual risk of hemorrhage. The annual risk of hemorrhage does not decrease with age. However, the natural history of non-operative AVM is difficult to follow up consistently for more than 30 years. In this report, we present a case with a large cerebral AVM which developed a major bleeding causing intraventricular hemorrhage (IVH) 31 years after the diagnosis. A male patient was proved to have a cerebral AVM in the right corpus callosum by cerebral angiography at ages 20 and 28. He was found losing consciousness due to rupture of AVM with IVH at age 51. A small cerebral aneurysm and a dilated vein (aneurysm) of Galen were noted also. A craniotomy with removal of the hematoma and microsurgical resection of the AVM was performed immediately, and the patient regained normal respiration and consciousness about 2 months and 7 months after craniotomy, respectively. We recommend that neurosurgeons should play active roles in encouraging young patients with large AVMs to receive microsurgical resection.