# A Case of Cerebral Arteriovenous Malformation and Malformation of the Lower Limbs

## TL;DR

A 37-year-old woman with a history of immune issues developed a brain arteriovenous malformation and later lower limb malformations after treatment.

## Contribution

This case highlights the rare occurrence of cerebral and lower limb arteriovenous malformations following embolization.

## Key findings

- The patient had a cerebral arteriovenous malformation that bled and required emergency surgery.
- Post-embolization, she developed severe femoral artery stenosis and additional lower limb malformations.
- The malformations in the lower limbs were discovered during surgical repair of the stenosis.

## Abstract

The case involves a 37-year-old female who was diagnosed with undifferentiated immunodeficiency and protein-losing gastroenteropathy at the age of 26 and was under outpatient care in the gastroenterology department while taking Prednisolone 15mg. At the age of 37, she experienced loss of consciousness and was diagnosed with a right occipital lobe arteriovenous malformation upon investigation. Although initially managed conservatively, she presented the following month with a right-sided headache and vomiting and was urgently transported to our hospital. Imaging with contrast-enhanced CT revealed bleeding from the arteriovenous malformation. Emergency craniotomy was performed, followed by ventricular drainage. Two weeks later, she underwent transcatheter arterial embolization of the main feeder via the right femoral artery approach, followed by excision of the arteriovenous malformation the next day. Subsequently, she had an uneventful recovery. A confirmation CT angiography before discharge revealed severe stenosis of the right common femoral artery, leading to a referral to the cardiovascular surgery department. The stenosis was attributed to the Pro-Glide used for hemostasis during the embolization procedure. Repair surgery was performed, during which CT angiography revealed arteriovenous malformations in both the popliteal fossae and the foot.