Case presentation

A previously healthy 17-year-old woman developed sudden-onset severe headache with vomiting and acute coma. At an outside emergency department, she underwent a non-contrasted CT scan of head, which showed an extensive spontaneous intraventricular haemorrhage (figure 1A,B). She was intubated for airway protection and admitted to our neurological intensive care unit. A CT cerebral angiogram showed a Spetzler-Martin grade 3 arteriovenous malformation with feeder aneurysm on the pericallosal artery, felt to be the bleeding source. The aneurysm was coiled and a ventriculostomy was placed. As she awakened, she developed abnormal eye movements when attempting upgaze (video 1). Her pupillary light and accommodative responses were intact (not shown in video).