Case 7 History ---- The patient was a 66 year old woman who was found unresponsive in her bathroom and sent to an outside hospital. A CT scan showed a left temporal-occipital hemorrhage with intraventricular and subdural extension. MRI revealed a left AVM, confirmed by angiogram. Subsequently she had residual deficits of left-sided hemiparesis, difficulty with speech and ophthalmoplegia. AVM embolization was performed and was complicated by the basilar artery thrombosis and occlusion after catheterization of the vertebral artery. Urokinase was infused to lyse the thrombus and to establish blood flow. Repeat angiogram (performed after thrombolysis in that evening) showed left vertebral artery patency with no evidence of thrombi. Repeat CT scan (post lysis of the thrombi in the basilar artery) revealed no evidence of mass effect or hemorrhage. After the embolization attempt the patient had worsening left hemiparesis but other clinical conditions remained stable. The patient subsequently developed a sudden episode of bradycardia and dropping oxygen saturation followed by apnea. CPR was performed without success.
