Hemodynamic aneurysm (HA) associated with arterio-venous malformation (AVM) is considered as one of the risk factors for intracranial hemorrhage.1–2 Aneurysm appears as a consequence of disruption in the cerebral autoregulatory mechanism which is induced by AVM. According to the previously reported literature, untreated HA after AVM exclusion can regress, remain unchanged, grow or rupture.1–4 Aim of the work: The aim of this case report is to describe a rare case of simultaneous presence of cortical arteriovenous malformation and saccular bifurcation aneurysm of a 48 years old patient for which he underwent clipping of aneurysm and total excision of AVM in sitting within very short interval of time and achieved favorable outcome. Case Report: A 48-year-old normotensive, non diabetic male presented with sudden onset of severe headache followed by loss of consciousness. After thorough radiological evaluation, he diagnosed as a case of right sided MCA bifurcation aneurysm and small cortical parietal AVM. At first sitting, he underwent right sided pterional craniotomy and clipping of the aneurysm. 5 days later, he underwent right parietal craniotomy, evacuation of hematoma and total excision of AVM. His postperative period was uneventful and discharged to home without having any neurological deficit. Conclusion: Proper preoperative work up, including angiogram should be done for any suspected vascular lesion. Considering the management of our reported case, the author recommended the simultaneous treatment of AVM and HA, which would be most beneficial to the patient.

Keywords: Aneurysm; Arterio-venous malformation; Hemodynamic instability.