It was better to treat the patient conservatively and operate him in better neurologic condition, but he showed deterioration, for what surgery was performed as life saving measure.

Despite the fact, that the AVM was huge, but the foot motor area was the most affected, as noticed in the follow up.

The patient was transferred from Grease after convulsion with loss of consciousness and dense left hemiplegia to Queen Alia Hospital 23-May-2002.

On examination: The patient has dense left sided hemiplegia, in Foley's catheter, bedridden with difficult verbal communication. CT-scan done 03-May-2002 showing bleeding of the right occipito-parietal lobes, fulfilling the right Sylvian and perichiasmatic areas.  4-vessel angiography performed at General Hospital of Athena 16-May-2002, showing the massive AVM with the feeders from right ACA, MCA and PCA. MRI with MRA done at Al-Khalidi Medical Center 25-May-2002 showed massive AVM with feeders from the right ACA, MCA and PCA with massive edema reaching anterior to the sensorimotor strip right side with hematoma with escalation of the edema in comparison to previous CT-scan. The patient was given medications to improve his condition, but he continued to deteriorate. The patient then transferred to Shmaisani hospital for surgical intervention.

Wide right fronto-parieto-occipital craniotomy with the flap extending to the left of mid and posterior third of the SSS and reflected to the right ear. The dura was widely opened to see all the pathologic arteries and veins. Dissection of the pathologic arteries started from tributaries of the right MCA at the Sylvian fissure. The pathologic arteries were isolated, coagulated and bisected. The feeders from the pericallosal arteries were followed interhemispheric, coagulated and bisected. It was possible to find the boundaries of the AVM which was followed and all feeders coming from posterior circulation were coagulated and bisected and the conglomerate of the AVM cluster was removed. Strict hemostasis and closure. The patient was sent to the ICU in ventilator but after several hours started to show conning, for what urgent CT-scan was performed showing huge extradural hematoma. The patient was taken another time to the operating room and the hematoma was removed, which was from the bone flap and the dura was opened to evacuate the xanthochromic CSF. The flap was waxed and the wound closed and the patient extubated.

Smooth postoperative recovery.  He was sent to the ICU and gradual recovery of his condition over several days took place.

The patient came to the clinic 13-July-2002 with left sided spastic hemiplegia. MRI of the brain done 19-August-2002 showing hydrocephalus  and no evidence for AVM. He progressed myositis ossificans right hip for what he was advised to be seen by orthopedics.

The patient then came 06-December-2002 with slight improvement of the plegia to paresis . He had convulsions 2 weeks ago.

The patient then came 16-February-2003 after performing manipulation of the left hip under G.A, He is convulsion free with continued improvement of his left sided paresis.

The patient then came 17-March-2009 walking with crutches with movement all muscles with no rigidity, except for severe weak dorsi and planterflexion left foot 0/5. MRI of the brain with MRA done 18-December-2009 showed the no evidence of AVM with cavity fulfilling the previous AVM. That was the last visit of the patient.