Primary intra-ventricular hemorrhage in 33-year-old man: a case report


  • Stephanie E. Gunawan Department of Neurology, Faculty of Medicine, Mataram University/West Nusa Tenggara Province Hospital, Mataram, Indonesia
  • Setyawati Asih Putri Department of Neurology, Faculty of Medicine, Mataram University/West Nusa Tenggara Province Hospital, Mataram, Indonesia



Intra-ventricular hemorrhage, Arterial venous malformation, Neurological


The aim of the study was to provide insight into cases of primary intra-ventricular hemorrhage caused by arterial venous malformations. A 33-year-old man visited the emergency room and admitted that he had a chief complaint of headache for the last 7 days. Neurological clinical examination only found nuchal rigidity. The CT scan of the head showed intra-ventricular hemorrhage and the CTA results showed an AVM with a left occipital nidus with arterialization of the posterior cerebral artery. One day before the DSA was performed, the patient had a seizure and based on a repeat CT scan, the bleeding spread to the parenchyma. The patient refused decompression and decided to go home after his condition stabilized and his complaints improved with anti-edema treatment. A repeat DSA action was planned but the patient had financial problems. Primary intra-ventricular hemorrhage occurs when the nidus arterial venous malformation is adjacent to the ventricle although this is only 7% of all cases of primary intra-ventricular hemorrhage. In the case of primary intra-ventricular hemorrhage, complications need to be wary of when hydrocephalus appears. In addition, digital subtraction angiography should be performed prior to endovascular surgery as the main modality of therapy. Arterial venous malformation can be one of the causes. Digital angiography and Endovascular measures should be performed in this patient to prevent further complications. However, the refusal of the patient and family until the time of this case report was made is a separate obstacle in the diagnostic and therapeutic process.


Hinson HE, Hanley DF, Ziai WC. Management of intra-ventricular hemorrhage. Curr Neurol Neurosci Rep. 2010;10(2):73-82.

Valdez Sandoval P, Hernández Rosales P, Quiñones Hernández DG, Chavana Naranjo EA, García Navarro V. Intra-ventricular hemorrhage and posthemorrhagic hydrocephalus in preterm infants: diagnosis, classification, and treatment options. Childs Nerv Syst. 2019;35(6):917-27.

Dorner RA, Burton VJ, Allen MC, Robinson S, Soares BP. Preterm neuroimaging and neurodevelopmental outcome: a focus on intra-ventricular hemorrhage, post-hemorrhagic hydrocephalus, and associated brain injury. J Perinatol. 2018;38(11):1431-43.

Ye Z, Ai X, Fang F, Hu X, Faramand A, You C. The use of neutrophil to lymphocyte ratio as a predictor for clinical outcomes in spontaneous intracerebral hemorrhage. Oncotarget. 2017;8(52):90380.

Hong T, Yan Y, Li J, Radovanovic I, Ma X, Shao YW, et al. High prevalence of KRAS/BRAF somatic mutations in brain and spinal cord arteriovenous malformations. Brain. 2019;142(1):23-34.

Subat YW, Dasenbrock HH, Gross BA, Patel NJ, Frerichs KU, Du R et al. Periprocedural intracranial hemorrhage after embolization of cerebral arteriovenous malformations: a meta-analysis. J Neurosurg. 2019;133(5):1417-27.

Barnaure I, Liberato AC, Gonzalez RG, Romero JM. Isolated intra-ventricular haemorrhage in adults. Br J Radiol. 2017;90(1069):20160779.

Trifan G, Arshi B, Testai FD. Intra-ventricular hemorrhage severity as a predictor of outcome in intracerebral hemorrhage. Front Neurol. 2019;10:217.

Milatović B, Saponjski J, Huseinagić H, Moranjkić M, Medenica SM, Marinković I et al. Anatomy of the feeding arteries of the cerebral arteriovenous malformations. Folia Morphol. 2018;77(4):656-69.

Stapf C, Mast H, Sciacca RR, Choi JH, Khaw AV, Connolly ES, et al. Predictors of hemorrhage in patients with untreated brain arteriovenous malformation. Neurology. 2006;66(9):1350-5.

Suzuki K, Kimura K, Takeuchi M, Morimoto M, Kanazawa R, Kamiya Y et al. The randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator in acute stroke with ICA and M1 occlusion (SKIP study). Int J Stroke. 2019;14(7):752-5.

De Leacy R, Ansari SA, Schirmer CM, Cooke DL, Prestigiacomo CJ, Bulsara KR et al. Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of Neuro Interventional Surgery Standards and Guidelines Committee. J Neuro Interventional Surg. 2022;0:1-10.






Case Reports