Paroxysmal sympathetic hyperactivity and cerebral salt wasting post management of arteriovenous malformation in a pediatric patient: A case report

Background: Spontaneous intracranial hemorrhage (ICH) is a rare presentation in healthy pediatric patients due to a myriad of conditions. Among them, arteriovenous malformations (AVMs) stand out for their potential to rupture and risk of death due to hemorrhagic strokes. A complication to consider in patients post ICH due to AVMs is the development of paroxysmal sympathetic hyperactivity (PSH) and cerebral salt wasting (CSW), as these complications further delay recovery and may lead to devastating results if left untreated. Case Description: We report a rare case of a 13-year-old female who developed a nontraumatic intracerebral hemorrhage due to a rupture of left AVM. She was managed with a decompressive craniotomy and further stabilized with two sessions of embolization. Following surgical intervention, she developed PSH and CSW, recovering through medical management. Conclusion: By highlighting this unique presentation in a previously healthy patient, we aim to deepen our understanding of the complexities surrounding fewer known causes of pediatric ICH, particularly in relation to nontraumatic AVMs, and to emphasize the importance of early diagnosis and intervention. Close monitoring and prompt assessment are required to prevent further complications in patients with PSH or CSW.