Papilledema in an Unbled Arteriovenous Malformation of the Brain (bAVM) – Pathophysiological Considerations on the Basis of a Case Report

We report on a 21-year-old male patient who presented with headaches and blurred vision to our emergency department.

Fundoscopy showed bilateral papilledema with beginning central venous thrombosis in the left eye.

Brain magnetic resonance imaging and cerebral angiography revealed an unruptured brain arteriovenous malformation (bAVM) of the splenium and body of the corpus callosum, Spetzler-Martin grade IV, 4.5 cm in diameter.

Rapid vision loss in one eye linked to the aggravating papilledema, unresponsive to Diamox, was felt most likely due to intracranial venous congestion and forced a surgical approach. The AVM was preoperatively embolized endovascularly and then removed in a surgical parieto-occipital midline approach. A small residual deep nidus was embolized endovascularly post-operatively.

The patient recovered completely from all symptoms and the AVM was absent at one year follow up angiography. The fundus was impressively normalized five months after surgery. MRI shows complete resection of the AVM. We exemplarily document the evolution of venous congestion and papilledema pre- and postoperatively as further validation for a not yet clear pathophysiologic phenomenon in unbled bAVM.