A Pediatric Case of Severe Cerebral Vasospasm due to Ruptured Arteriovenous Malformation

Cerebral vasospasm is a well-documented occurrence of aneurysmal subarachnoid hemorrhage but has not been sufficiently analyzed in cases with arteriovenous malformation. Moreover, cerebral vasospasm following arteriovenous malformation rupture is a rare and critical complication. We describe a case of symptomatic cerebral vasospasm following cerebellar arteriovenous malformation rupture. An 8-year-old girl presented with deteriorated consciousness. Computed tomography revealed packed intraventricular and diffuse thin subarachnoid hemorrhages due to cerebellar arteriovenous malformation. Immediate endoscopic evacuation of intraventricular hemorrhage was performed. Subsequently, total arteriovenous malformation resection was achieved surgically after preoperative glue embolization. Twelve days posthemorrhage, cerebral angiogram revealed severe vasospasm at both internal carotid arteries. Although emergency intra-arterial fasudil hydrochloride injection and balloon angioplasty resolved the vasospasm successfully, postoperative magnetic resonance imaging showed bifrontal cerebral infarction. The characteristic features of cerebral vasospasm after arteriovenous malformation rupture are discussed. In the present case, packed intraventricular hemorrhage could strongly affect significant vasospasm. Treatment of patients with intraventricular hemorrhage related to arteriovenous malformations should consider the risk of severe delayed vasospasm.