Spinal arteriovenous malformations
Updates to Article Attributes
Spinal arteriovenous malformations (AVMs) are characterised by arteriovenous shunting with or without a true nidus, and includes both arteriovenous fistulae and arteriovenous malformations.
Demographics and clinical presentation
Different types of spinal AVM (see below) have differing age of presentation, but overall 80% present between the age 20 and 60 years 3. Clinical presentation is variable, ranging from the progressive myelopathy (Foix-Alajouanine syndrome), often with delayed diagnosis, to the catastrophic spinal subarachnoid haemorrhage (see coup de poignard of Michon 3)
Classification
Spinal AVM's may be classified as intramedullary and extramedullary (80%) 1 and further divided into 4 angiographic types, with additional sub types 2-3 (please refer to spinal AVM classification)
Radiographic features
DSA - angiogrpahy
Angiography remains the investigation of choice, but requires meticulous technique. It is essential to remember that the site of arterial supply can be anywhere from the upper thoracic to sacral areas with little relationship to the clinical level, or visible nidus (if present).
MRI
-
T1
:- signal voids from high velocity flow
- dilated perimedullary vessels indent / scallop the cord 1
-
T2
:- signal voids from high velocity flow 1
- increased signal due to cytotoxic oedema or myelomalacia 1
Complications
- myelopathy from venous congestion
-<p><strong>Spinal arteriovenous malformations (AVMs)</strong> are characterised by arteriovenous shunting with or without a true nidus, and includes both arteriovenous fistulae and arteriovenous malformations.</p><h4>Demographics and clinical presentation</h4><p>Different types of spinal AVM (see below) have differing age of presentation, but overall 80% present between the age 20 and 60 years <sup>3</sup>. Clinical presentation is variable, ranging from the progressive myelopathy (<a href="/articles/foix-alajouanine-syndrome">Foix-Alajouanine syndrome</a>), often with delayed diagnosis, to the catastrophic spinal <a href="/articles/subarachnoid-haemorrhage">subarachnoid haemorrhage</a> (see <a href="/articles/coup-de-poignard-of-michon">coup de poignard of Michon </a><sup>3</sup>)</p><h4>Classification</h4><p>Spinal AVM's may be classified as intramedullary and extramedullary (80%) <sup>1</sup> and further divided into 4 angiographic types, with additional sub types <sup>2-3</sup> (please refer to <a href="/articles/spinal_avm">spinal AVM classification</a>)</p><h4>Radiographic features</h4><h5>DSA - angiogrpahy</h5><p>Angiography remains the investigation of choice, but requires meticulous technique. It is essential to remember that the site of arterial supply can be anywhere from the upper thoracic to sacral areas with little relationship to the clinical level, or visible nidus (if present). </p><h5>MRI</h5><ul>- +<p><strong>Spinal arteriovenous malformations (AVMs)</strong> are characterised by arteriovenous shunting with or without a true nidus, and includes both arteriovenous fistulae and arteriovenous malformations.</p><h4>Demographics and clinical presentation</h4><p>Different types of spinal AVM (see below) have differing age of presentation, but overall 80% present between the age 20 and 60 years <sup>3</sup>. Clinical presentation is variable, ranging from the progressive myelopathy (<a href="/articles/foix-alajouanine-syndrome">Foix-Alajouanine syndrome</a>), often with delayed diagnosis, to the catastrophic spinal <a href="/articles/subarachnoid-haemorrhage">subarachnoid haemorrhage</a> (see <a href="/articles/coup-de-poignard-of-michon">coup de poignard of Michon </a><sup>3</sup>)</p><h4>Classification</h4><p>Spinal AVM's may be classified as intramedullary and extramedullary (80%) <sup>1</sup> and further divided into 4 angiographic types, with additional sub types <sup>2-3</sup> (please refer to <a href="/articles/spinal-avm-classification">spinal AVM classification</a>)</p><h4>Radiographic features</h4><h5>DSA - angiogrpahy</h5><p>Angiography remains the investigation of choice, but requires meticulous technique. It is essential to remember that the site of arterial supply can be anywhere from the upper thoracic to sacral areas with little relationship to the clinical level, or visible nidus (if present).</p><h5>MRI</h5><ul>
-<strong>T1</strong> : <ul>- +<strong>T1</strong><ul>
-<strong>T2</strong> :<ul>- +<strong>T2</strong><ul>
Systems changed:
- Spine
Image 1 DSA (angiography) ( update )
Image 2 MRI (T2) ( update )
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