Background Arteriovenous malformations (AVMs) can occur in all regions of the brain and spinal cord, with clinical consequences and risks varying by location. Delayed AVM rupture despite digital subtraction angiography–confirmed obliteration post-radiation is exceedingly rare. Case Description To our knowledge, we present the first documented case of delayed hemorrhage associated with a cerebellar AVM 5 years after linear accelerator–based radiation in a man aged 31 years despite apparent angiographic obliteration. Conclusions Intracranial hemorrhage after radiosurgery in digital subtraction angiography–confirmed obliterated AVMs is rare, with limited understanding of risk factors, appropriate preventative management, and mechanisms of occurrence. This case serves to demonstrate the need for greater awareness of this rare complication, as well as the need for appropriate surveillance and management strategies.
