Ruptured cerebral arteriovenous malformation during fifth pregnancy: A case report and literature review.

Whether the risk of rupture of a cerebral arteriovenous malformation (AVM) increases during pregnancy remains controversial. Moreover, it is unclear whether the number of pregnancies correlates with AVM rupture risk. We report a case of ruptured AVM during the fifth pregnancy.

A 34-year-old woman presenting sudden headache and vomiting was admitted to our hospital. Neuroimaging revealed a subarachnoid hemorrhage due to a ruptured AVM in the right temporal lobe. She was pregnant (9 weeks and 1 day), and she had previously experienced four normal vaginal deliveries (gravidity and parity G₄P₄) without complications. Elective treatment including neuroendovascular and direct surgery was performed, and the AVM was safely resected (at 15 weeks 6 days of pregnancy). She underwent elective caesarean section without complications 151 days following the AVM resection (at 37 weeks 1 day of pregnancy), and the baby was healthy.

This report suggests that the risk of AVM rupture persists even after multiple deliveries. Intracranial hemorrhage should be suspected even in pregnant patients who underwent multiple deliveries, and a rapid diagnosis and appropriate treatment are necessary.