Arterio-Venous Brain Malformation Rupture during Pregnancy, About a Case

Abstract

AVMs are abnormalities of the intracranial vessels that constitute a connection between the arterial and venous systems and lack an intervening capillary bed. Hemorrhagic presentation of AVM is associated with significant morbidity and mortality; it is an independent predictor of future hemorrhage. AVM rupture is one of the most frequent and important causes of hemorrhagic stroke during pregnancy and puerperium. Whether the risks of AVM rupture increases during pregnancy and puerperium is controversial, but maternal physiological changes in hemodynamics, blood volume, and hormonal effects on the vessel walls could potentially increase the risk of hemorrhage from AVMs during pregnancy and in the postpartum period. For AVM during pregnancy and puerperium, previous studies have demonstrated histologic changes in arteries and arterioles of pregnant women, thought to be mediated by progesterone; the changes included fragmentation of reticular fibers and loss of normal corrugation of elastic fibers, which might play a role in the increased risk for AVM hemorrhage during pregnancy. However, there is insufficient evidence to guide management decisions for ruptured AVMs during pregnancy, and further well-designed, multicenter, perspective clinical trials are needed. We report the case of a young woman, who had an emergency ceasarean surgery for a headeck and consciousness disorder witch evoked eclampsia, while in fact; she had a rupture of arteriovenous malformation following the rupture of a cerebral Arterio-venous malformation in cerebral imaging.