Goals of Treatment Rapid recognition of a child with acute neurologic decline, initial stabilization, and acquisition of cerebral imaging CLINICAL PEARLS AND PITFALLS Approximately 5% of the population have cerebrovascular malformations including arteriovenous malformations (AVMs), cavernous malformations, venous angiomas, and capillary telangiectasias Unruptured aneurysms and certain types of cerebral vascular malformations are asymptomatic Clinical presentations in infants may be nonspecific AVMs typically present with spontaneous hemorrhage and/or seizure Clinical Considerations The presentation of the various types of cerebral vascular malformations may be insidious Often, these malformations are asymptomatic The presentation of infants may be very nonspecific and include poor feeding, vomiting, irritability, bulging anterior fontanelle, and altered mental status Typical complaints in children include headache that may be localized, early morning awakening due to headache, progression of headache with increasing severity and/or frequency, vomiting, visual changes, neck stiffness, focal neurologic findings, altered mental status, seizure, lethargy, or obtundation Signs of impending cerebral herniation include lethargy, pupillary changes, bradycardia, hypertension, and respiratory depression Surgical management of the lesion directly or of elevated intracranial pressure (ICP) is imperative Cerebral Aneurysm Current Evidence Aneurysm rupture causing subarachnoid hemorrhage is the most common presentation of a patient with a cerebral aneurysm, followed by mass effect and seizures Less than 10% of pediatric cerebral