[Hemorrhagic rupture of a giant arteriovenous malformation in a young man in Ouagadougou].

Vascular arteriovenous malformations (VAM) are aggressive vascular diseases associated with increased haemorrhagic risk in terms of morbidity and mortality. Vascular arteriovenous malformations are usually sporadic. The main symptom of VAM is hemorrhage, in 50% of cases. We here report the case of a 28 year old patient, hospitalized with right sided motor deficit of acute onset associated with consciousness disorder in the Department of Neurology at the Yalgado Ouédraogo University Hospital Center. The patient had a history of chronic headaches treated with self-medication and of right Bravais-Jacksonian seizures. Neurological examination, performed on admission, showed proportional right hemiplegia, Broca's aphasia, left eye pain associated with ptosis, left chemosis and febrile meningeal syndrome with a temperature at 40°C. On admission the NIHSS score was 21/42 and the ICH score was 2. Emergency cerebral CT scan showed cerebral hemorrhage in the basal ganglia and in the brainstem, intra-ventricular flood and basal cisterns. Blood count showed leukocytosis at 13 200/mm3 with granulocytic predominance (72.6%). Chest X-ray showed right alveolar pneumopathy. Tuberculin intradermal reaction (IDR) was positive to 17mm. Cerebral angioscanner, performed on day 24, showed arteriovenous malformation of the middle cerebral arteries and of the posterior vertebral arteries as well as thrombosis of the cavernous sinuses.