| Sumario: | Objective To report the diagnosis and treatment of a young patient with type 1 diabetes mellitus complicated by ruptured cerebral aneurysm and arteriovenous malformation (AVM), providing clinical strategies and management insights for handling critical and complex cerebrovascular diseases. Methods and Results A 19-year-old female with type 1 diabetes mellitus presented with acute intracerebral hemorrhage. Imaging revealed the hemorrhage was caused by rupture of multiple beaded aneurysms on a prominent lenticulostriate artery (LA) originating from the M1 segment of middle cerebral artery (MCA). This vascular pathology was accompanied by a caput medusae-like AVM (Spetzler-Martin grade IV) in the Sylvian fissure region. The neurosurgical team formulated and implemented a combined, staged therapeutic strategy. The first- stage procedure involved embolization of the lenticulostriate artery aneurysms, surgical evacuation of the hematoma, and decompressive craniectomy. This was followed by staged endovascular embolization of the AVM. Ultimately, curative embolization of all aneurysms and the AVM was successfully achieved while preserving the blood supply to normal brain tissue. Throughout the perioperative period, continuous glucose monitoring (CGM) was utilized to precisely titrate insulin dosage and maintain strict glycemic control. Conclusions For such rare cerebrovascular lesions characterized by complex anatomy and high-risk hemodynamics, a personalized, staged comprehensive strategy is crucial for achieving complete occlusion of the lesions while maximally preserving neurological function. The successful management of this case provides a referable multidisciplinary collaborative framework and clinical decision-making rationale for handling similar critical and complex cerebrovascular diseases.
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