Pediatric cerebral arteriovenous malformation diagnosed 11 years after neonatal thalamic hemorrhage: illustrative case.

BACKGROUND

Arteriovenous malformations (AVMs) are known as congenital vascular disorders. However, ruptured AVMs in neonates are extremely rare. A hypothesis suggests that micro-AVM or de novo AVMs enlarge during childhood, eventually acquiring the pathological features of adult AVMs. The authors describe a case of a pediatric AVM diagnosed 11 years after neonatal intracerebral hemorrhage.

OBSERVATIONS

A 16-day-old neonate presented with sudden vomiting and convulsions. CT revealed a left thalamic hemorrhage extending into the left lateral ventricle. MRI showed no bleeding sources, including AVMs. By the age of 3 years, the patient developed West syndrome and was administered multiple antiseizure medication. At 5 years of age, the patient experienced convulsive status epilepticus, primarily on the right side of his body. A focal impaired awareness seizure due to the previous hemorrhage was considered. The patient remained seizure free until 11 years of age, when generalized seizures developed. MRI revealed a left thalamic AVM classified as Spetzler-Martin grade IV. The patient has been scheduled to undergo stereotactic radiosurgery.

LESSONS

Pediatric AVMs can undergo dynamic changes, including enlargement and de novo formation, acquiring the pathological features of adult AVMs. AVMs should be considered as a potential source of neonatal intracranial hemorrhage, necessitating long-term follow-up. https://thejns.org/doi/10.3171/CASE25124.