Acute neurological events in a patient with secondary polycythaemia and arteriovenous malformations

General internists and adult cardiologist are seeing adult congenital heart disease more frequently in their clinical practices. We report the case of a polycythaemic patient with the cerebral and pulmonary arteriovenous malformations (AVMs) who presents with a transient ischaemic attack (TIA). Treatment strategies such as antiplatelet drugs and vensection may at best be ineffective and at worst detrimental to the patient. [Copyright &y& Elsevier]