Brain arteriovenous malformation recurrence-recanalization or rebirth?

BACKGROUND: Bleeding secondary to recurrences of spontaneously obliterated arteriovenous malformations (AVMs) is an extremely rare occurrence. CASE DESCRIPTION: We report a 25-year-old man with cerebellar hemorrhage secondary to a recurrent AVM. His current admission with bleeding from a ruptured cerebellar AVM followed a previous presentation 15 years earlier with the similar clinical picture of AVM rupture within the same vascular territory. At that time, he was managed conservatively with follow-up digital subtraction angiography (DSA) 2 years later, confirming no residuum of the AVM. At the current presentation, he had DSA confirming AVM recurrence. He was managed by complete excision of the AVM via a suboccipital craniotomy. CONCLUSION: This case illustrates the need for long-term imaging follow-up to exclude recanalization even many years after AVM obliteration.