Recurrent Haemorrhage due to Cerebral Arterio-venous malformation in successive Pregnancies: A rare Presentation

Abstract

Introduction: The rupture of an intracranial Arteriovenous Malformation (AVM) in pregnancy is a rare occurrence, but may have fatal maternal and fetal consequences. Association between AVM rupture and pregnancy has been proposed which may be caused by increased cardiac output or circulatory effects of the elevated estrogen levels. The presentation during the pregnancy is usually as a result of Intracerebral Haemorrhage (ICH) following their rupture. Prognosis depends on the site, size, angio-architecture of AVM and extent of bleed. The risk of rebleed in an untreated symptomatic AVM is increased and mortality rate associated with the second bleed is 13% with the rate increasing to 20% for each subsequent haemorrhage. Till date, only a few reports have been published with a rebleed in cerebral AVM in pregnancy. Case report: We report a case of a 29 year old female who presented with ICH following ruptured occipital AVM in both her pregnancies. She was managed conservatively in her pregnancy followed by Gamma knife surgery in the postpartum period. Despite a rebleed in AVM, she had good maternal and fetal outcomes.