Obstructive hydrocephalus is a rare complication of brain AVM's. It usually diagnosed because of posterior fossa AVM's. This article is about a case of a 40-year-old female patient suffering from a right fronto-parietal unruptured grade IV AVM located in the central sulcus who developed obstructive hydrocephalus and worsening of left sided weakness and spasticity. The AVM has been embolized twice in the past and no further treatment was offered because of the adjacent motor cortex and concerns of permanent neurological damage. Patient was treated with navigated ventricular-peritoneal shunt with a programmable valve. Interestingly there was an improvement of spasticity and weakness.