Clinical case of a pregnant woman with arteriovenous malformation, hemorrhagic venous infarcts and epileptic seizures: a case report

BACKGROUND: Acute cerebrovascular incidents and epileptic seizures during pregnancy remain significant challenges for neurologists. The required neuroimaging techniques in both conditions and treatment options may have serious negative effects on the fetus. CASE PRESENTATION: A 30-year-old pregnant white European woman at the 6th gestational week was hospitalized due to acute focal neurological symptoms from the left cerebral hemisphere. The patient conceived through an in vitro procedure and was on hormonal therapy with progesterone and estradiol. The brain CT showed suspicion of a venous infarct in the left cerebral hemisphere. Three days later, new acute neurological symptoms occurred, this time from the right cerebral hemisphere. The brain MRI revealed an arteriovenous malformation (AVM) in the left parietal lobe, superior sagittal sinus thrombosis, and hemorrhagic venous infarcts in both cerebral hemispheres. Ten days after the first symptoms, the patient developed an epileptic status characterized by focal clonic jerks on the right side of the face and right arm. Due to worsening health condition, a decision was made to perform an abortion. In addition, the patient was diagnosed with thrombophilia. Endovascular embolization of the arteriovenous malformation was not performed due to the high risk of complications. The patient was left on conservative treatment with levetiracetam and apixaban, but after two more hospitalizations because of epileptic status, the patient was referred for stereotactic radiosurgery. CONCLUSION: This clinical case presents interest due to the combination of medical conditions, which resulted in cerebrovascular incidents with different localizations and characteristics during pregnancy, complicated with epileptic seizures.