Multiple Cerebral Arteriovenous Malformation: Report of Two Cases and Treatment Strategy

Multiple arteriovenous malformations (AVM) are relatively rare, accounting for 0.3 to 4.9% of all AVMs. We describe two cases of young patients with multiple cerebral AVMs and discuss their diagnosis and treatment planning. Both patients presented with sudden headache. In patient 1, a 17-year-old female, angiography demonstrated multiple right-sided AVMs. In patient 2, a 13-year-old male, head CT showed a right parietal intraparenchymal hemorrhage. Following emergency surgery to evacuate the hematoma, cerebral angiography demonstrated two separate nidi filled by the right posterior cerebral artery. Multiple cerebral AVMs are a rare and therapeutically challenging condition. While they are often syndromic, we were unable to diagnose any identifiable syndromes in our patients. A multidisciplinary approach is needed to discuss and decide the best treatment strategy for each patient. Treatment is as for single AVMs, and must take into account bleeding, location, size, and number of malformations.