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At clinical examination, the patient had paresis of the left upper limb, with the rest of the neurological examination being normal.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A brain MRI was performed, visualizing the entire right cerebral hemisphere with signal-void structures in relation to vasodilation and a hyperintense lesion in the parietal region, compatible with an evolving parenchymal haemorrhagic foci (grey arrow, <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The examination was completed with an angio-MRI using a paramagnetic contrast agent, visualizing multiple engorged vascular structures in the entire right cerebral hemisphere, by a grade VI arteriovenous malformation (AVM) according to the Spetzler-Martin grading system: vascular nidus larger than 6<span class="elsevierStyleHsp" style=""></span>cm, eloquent parenchymal area, and venous drainage into the superficial and deep systems (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0020" class="elsevierStylePara elsevierViewall">AVMs are the result of congenital abnormalities in vascular morphogenesis, there is a direct communication between arterial and venous channels without an intervening capillary network.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Most are asymptomatic and are detected as incidental findings. When they are symptomatic, approximately 50% of patients start with signs and symptoms secondary to haemorrhage. In our case, a right parietal parenchymal haemorrhage was detected, possibly related to the clinical worsening in recent months.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Menal Muñoz P, Saez Valero E, Muñoz Jalle E, Gimeno Peribañez MJ. Cefalea hemicraneal secundaria a una malformación arteriovenosa gigante. 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