Delayed diagnosis of AVM presenting with stroke and seizures in a young Nigerian: A case report

Abstract

Background: Brain arteriovenous malformations (BAVM) are a cause of intracerebral haemorrhage (ICH) and seizures especially in young patients. ICH due to BAVMs seem to have relatively better neurologic  outcomes compared to other causes of spontaneous ICH as patients often recover fully. In this report we highlight a case of delayed diagnosis of BAVM in a young man who presented with seizures and stroke.
Case summary: A 36-year-old man was referred on account of focal, secondarily generalized tonic clonic  convulsions. He had suffered a right ICH 3 years before the index presentation. His general physical and  neurologic examination were normal. Electroencephalography revealed right sided focal epileptiform  discharges and brain MRI revealed a right parieto-occipital AVM. The seizures were controlled with  carbamazepine and he was referred for neurosurgical evaluation.
Conclusion: BAVMs are an important cause of intracerebral haemorrhage and attendant neurologic  morbidity especially in young individuals. Neuroimaging plays a central role in BAVM diagnosis and MRI is  of great value where facilities and expertise for conventional angiography do not exist. In some  instances, delayed presentation of BAVM cases may be due to relatively better neurologic outcomes in  BAVM-related ICH.