{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:07:07Z","timestamp":1779361627535,"version":"3.51.4"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"20","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,5,18]]},"abstract":"\n BACKGROUND<\/jats:title>\n Vein of Galen malformations (VOGMs) are congenital arteriovenous shunts that typically present in neonates and infants. Symptomatic neonates have a poor prognosis and face high mortality without dedicated neonatal intensive care and pediatric neurointervention in specialized centers.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors present the case of a 47-year-old Puerto Rican female with a history of chronically compensated heart failure, progressive cognitive decline, and new-onset seizures. On presentation, the patient had a Glasgow Coma Scale score of 6, and CT imaging revealed intraventricular hemorrhage, extensive parenchymal calcifications, and hydrocephalus. An external ventricular drain was urgently placed, and further workup at the authors\u2019 institution, including CT angiography and digital subtraction angiography, led to the diagnosis of a choroidal VOGM. The patient\u2019s family opted for withdrawal of care without pursuing further neurosurgical intervention.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n The presentation of a choroidal VOGM at this advanced age is exceptionally rare. This case highlights the importance of understanding the presentations and consequences of this life-threatening condition, as well as considering endovascular or microsurgical intervention. Specifically, workup for cerebrovascular abnormalities should be strongly considered in patients with neurodegenerative presentations at atypical ages without a clear cause, as early diagnosis and management can significantly impact patient outcomes.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25684<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25684","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:55:26Z","timestamp":1779108926000},"source":"Crossref","is-referenced-by-count":0,"title":["Adult presentation of a vein of Galen malformation as cognitive decline in a 47-year-old multiparous female: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7642-0819","authenticated-orcid":true,"given":"Esteban","family":"Rivera-Rivera","sequence":"first","affiliation":[{"name":"Department of Surgery, Neurosurgery Section, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5034-3867","authenticated-orcid":true,"given":"Karen S.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7814-3867","authenticated-orcid":true,"given":"Joshua D.","family":"Bernstock","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nirav J.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7720-803X","authenticated-orcid":true,"given":"Gisela","family":"Murray-Ortiz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Neurosurgery Section, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1903-8485","authenticated-orcid":true,"given":"Juan","family":"Vicenty-Padilla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Neuroradiology","first-page":"109","article-title":"Aneurysms of the vein of Galen: embryonic considerations and anatomical features relating to the pathogenesis of the malformation","volume":"31","author":"Raybaud","year":"1989","unstructured":"Raybaud CAStrother CMHald JK.Aneurysms of the vein of Galen: embryonic considerations and anatomical features relating to the pathogenesis of the malformation. 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World J Clin Pediatr. 2017;6(1):103-109. doi:10.5409\/wjcp.v6.i1.103"},{"issue":"2","key":"bib4","series-title":"J Pediatr Neurol","first-page":"45","article-title":"Vein of Galen aneurysmal malformation: an updated review","volume":"17","author":"Cao","year":"2019","unstructured":"Cao LRCai CQ.Vein of Galen aneurysmal malformation: an updated review. J Pediatr Neurol. 2019;17(2):45-56. doi:10.1055\/s-0038-1635108"},{"issue":"1","key":"bib5","series-title":"Neuroradiol J","first-page":"72","article-title":"Vein of Galen aneurysmal malformation: prognostic markers depicted on fetal MRI","volume":"28","author":"Wagner","year":"2015","unstructured":"Wagner MWVaught AJPoretti ABlakemore KJHuisman TA.Vein of Galen aneurysmal malformation: prognostic markers depicted on fetal MRI. 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Clin Neurol Neurosurg. 2023;228:107671. doi:10.1016\/j.clineuro.2023.107671"},{"key":"bib10","series-title":"World Neurosurg","first-page":"73","article-title":"Interhemispheric transcallosal approach for resection of choroidal arteriovenous malformation: operative video","volume":"136","author":"Domingo","year":"2020","unstructured":"Domingo RAGrewal STawk RG.Interhemispheric transcallosal approach for resection of choroidal arteriovenous malformation: operative video. World Neurosurg. 2020;136:73. doi:10.1016\/j.wneu.2019.12.126"},{"key":"bib11","series-title":"Clin Neurol Neurosurg","first-page":"146","article-title":"Pure word deafness after resection of a vein of Galen aneurysm and arteriovenous malformation: report of a case","volume":"123","author":"Bervini","year":"2014","unstructured":"Bervini DOxenham VMorgan MK.Pure word deafness after resection of a vein of Galen aneurysm and arteriovenous malformation: report of a case. 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