CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(02): 400-403
DOI: 10.1055/s-0043-1769893
Case Report

Idiopathic De Novo Arteriovenous Malformation: A Rare Acquired Intracranial Lesion

Tritan Plute
1   University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
Prateek Agarwal
2   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
Aneek Patel
3   Department of Neurological Surgery, New York University Langone Health, New York, New York, United States
2   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
L Dade Lunsford
2   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
Hussam Abou-Al-Shaar
2   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
› Author Affiliations
Funding None.


The de novo development of cerebral arteriovenous malformations (AVMs) in adults is an exceedingly rare event that has prompted the theory that a “second hit” is required to induce AVM formation. The authors document development of an occipital AVM in an adult a decade and a half after a brain magnetic resonance imaging (MRI) disclosed no abnormality. A 31-year-old male with a family history of AVMs and a 14-year history of migraines with visual auras and seizures presented to our service. Because of the onset of a first seizure and migraine headaches at age 17, the patient underwent high-resolution MRI that showed no intracranial lesion. After 14 years of progressively worsening symptoms, he underwent a repeat MRI that demonstrated a new de novo Spetzler-Martin grade 3 left occipital AVM. The patient received anticonvulsants and underwent Gamma Knife radiosurgery for his AVM. This case suggests that patients with seizures or persistent migraine headaches should have periodic repeat neuroimaging to exclude the development of a vascular cause despite an initial negative MRI.

Authors' Contributions

Tritan Plute was responsible for data collection, writing and primary generation of the manuscript. Prateek Agarwal was the primary resident involved with the case and provided insight into the case and assisted with writing. Aneek Patel was involved with the case write-up and provided neurosurgical insight. Arka Mallela provided key insight into the research process and assisted with manuscript writing. Lunsford was responsible for identifying the case as novel, obtaining patient consent, writing, and providing expert opinion regarding the case. Abou-Al-Shaar was responsible for the design of the report and advising Plute during the research process; he was also responsible for writing manuscript generation.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee of University of Pittsburgh Medical Center and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from the patient included in the study.

Publication History

Article published online:
16 June 2023

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