Jul 16, Kathmandu - Kathmandu Medical College (KMC) has successfully treated a 67-year-old man with a complex brain blood vessel disorder called Arteriovenous Malformation (AVM) through neurointervention techniques, without the need for open brain surgery. This marks possibly the first such case in Nepal.

Hariprasad Kandel of Banke, who had long-standing liver disease, suddenly lost consciousness. His family rushed him to the emergency department at KMC. After nearly three hours of unconsciousness, a CT scan revealed abnormal bleeding (hematoma) in an unusual location in his brain.

Given the unusual site of bleeding, KMC’s advanced biplane cath lab and neurointervention specialists, led by Dr. Arun Poudel, conducted a DSA angiography to determine the cause. The imaging confirmed that a congenital abnormal blood vessel network—an AVM—had ruptured, causing the bleeding. A team including liver specialists led by Dr. Sagar Poudel also participated in the treatment.

According to doctors, AVM is a rare congenital vascular disorder that usually presents or ruptures at a younger age. The occurrence of a rupture at the age of 67 is extremely rare and high-risk.

Following diagnosis, the medical team performed a minimally invasive procedure, inserting a tiny catheter through a scalp artery to reach the brain. Using endovascular techniques, including stents and balloons, they successfully occluded the AVM, controlling the bleeding without open surgery. The hospital reported that the complex procedure was successful in safely sealing the abnormal blood vessels.

Post-treatment, Kandel’s condition significantly improved, and he is now in stable health. He expressed gratitude towards the medical team for the effective and painless treatment.

Dr. Poudel emphasized that in cases of abnormal brain bleeding, it’s crucial not to dismiss it as a simple stroke. Conditions like AVM or aneurysm should be considered, and detailed neurointervention diagnostics like DSA angiography are essential. Timely and accurate diagnosis can save many lives, he added.