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The Worst Headache of Her Life 

The Worst Headache of Her Life

Chapter:
The Worst Headache of Her Life
Author(s):

M. Angela O’Neal

DOI:
10.1093/med/9780190609917.003.0021
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date: 22 July 2017

The case is an example of a ruptured arteriovenous malformation (AVM) causing an intracranial hemorrhage during pregnancy. Volume changes that occur during pregnancy predispose to AVM rupture. These changes peak at 25–30 weeks of gestation. An unruptured AVM if identified should be treated in the nonpregnant state. Once there has been a hemorrhage related to an AVM the risk of re-rupture is high. Therefore, treatment is dictated by best neurosurgical considerations rather than obstetric concerns. If an AVM ruptures near term an emergent caesarian-section and hemicraniectomy could be done in tandem.

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