Bilateral papilledema.

PATIENT PRESENTATION

A 53‐year‐old male with a history of a brain aneurysm coiled 14 years ago and diabetes mellitus presented to the emergency department for transient bilateral visual loss and intermittent pulsating headaches. The patient was sent in by his ophthalmologist for bilateral papilledema. The patient recently was discharged from the hospital 3.5 weeks ago after suffering a traumatic left‐sided subdural hematoma. At that time, the patient was observed without any progression of the intracranial hemorrhage. On physical examination, visual acuity was 20/20 bilaterally. Neurological examination was normal. Brain computed tomography showed embolization coils in the left circle of Willis that were unchanged from previous studies. Lumbar puncture was performed by interventional radiology with a normal opening pressure in a lateral decubitus position.

DIAGNOSIS

Post‐subdural hematoma arteriovenous malformation (AVM).

DISCUSSION

Brain magnetic resonance angiography/magnetic resonance venography (Figures 1, 2, 3, 4) revealed a moderate‐sized AVM in the left posterior temporal‐occipital area with contributions from the peripheral aspect of the posterior cerebral arteries. Patient was admitted and taken to the operating room with neurosurgery for a cerebral angiogram and subsequent embolization of the AVM. On follow‐up, the patient's visual symptoms resolved.

FIGURE 1

Magnetic resonance imaging of the brain identifying the cause of the patient's symptoms. AVM indicated by the white arrow

FIGURE 2

Magnetic resonance imaging of the brain identifying the cause of the patient's symptoms. AVM indicated by the white arrow

FIGURE 3

Magnetic resonance imaging of the brain identifying the cause of the patient's symptoms. AVM indicated by the white arrow

FIGURE 4

Magnetic resonance imaging of the brain identifying the cause of the patient's symptoms. AVM indicated by the white arrow

Post‐traumatic AVMs usually are caused by traumatic penetrating injuries to vasculature. Penetrating injury induced AVMs can be clinically asymptomatic or can present as a murmur with or without a palpable thrill or a pulsatile mass. , However, the development of an AVM following an intracranial hemorrhage has never been reported in the literature. Radiological imaging is critical in identifying and localizing these vascular anomalies. Following diagnosis, neurosurgery should be emergently consulted for operative embolization to prevent complications of thrombosis, embolism, infection, and rupture.