Vein of Galen malformation presentation in parturient: Case report

Introduction: A Vein of Galen (VOG) malformation is congenital malformation of blood vessels of brain, representing less than 1%of intracranial vascular malformations. It usually presents in early childhood but rarely it presents in adulthood also. Case Summary: A 22 year female was brought to emergency department of obstetrics and gynaecology, in our institution with complaint of altered sensorium and seizures 2 days postpartum. Airway was secured with endotracheal intubation under sedation. Eclampsia was questioned with normal BP and negative urine proteins and no past history of hypertension during pregnancy. Antiepileptic drugs were started. Patient had a history of headache once or twice a month since childhood which was considered as migraine and was not investigated further. Brain imaging was done which showed bilateral dilated ventricles with a lesion posterior to thalamus with intensity of that of blood vessels. which conformed a diagnosis of VOG malformation. An emergency ventriculoperitoneal shunting was done to relieve increased intracranial pressure. And after stabilization of patient she was referred for endovascular procedure. Conclusion: Every chronic headache should be investigated and brain imaging should be done. And every postpartum patient with seizures is not eclampsia, even if a patient presents with sudden onset of seizures after delivery with no past history of preeclampsia or eclampsia, she should be subjected to brain imaging and complete neurology workup.