Spinal arteriovenous malformation

Case contributed by Dr. Abdalla Al-Khashmani

Presentation

Sudden onset of both lower limb numbness and paraparesis.

Patient Data

Age: 15 years old
Gender: Female
Modality: MRI

The lower spinal cord / conus medullaris appears swollen & edematous (cytotoxic oedema / myelomalacia) associated with surrounding prominent serpiginous intradural extramedullary flow voids (dilated perimedullary vessels) extending down around the filum terminale. Heterogeneous low signal intensity on GRE images also noted suggestive of cord hemorrhage. Patchy intramedullary enhancement is also noted.

Findings are highly suggestive of spinal dural arterio-venous fistula/malformation.

Case Discussion

Spinal arteriovenous malformations (AVMs) are characterised by arteriovenous shunting with or without a true nidus, and includes both arteriovenous fistulae and arteriovenous malformations.

Spinal AVM's may be classified as intramedullary and extramedullary (80%).

An accurate diagnosis is important because these lesions may represent a reversible cause of myelopathy.

If a spinal vascular malformation is still suspected, digital subtraction angiography (DSA) must be performed to display the very small vessels of the spinal cord. Owing to the complications involved with DSA, an MRA or CTA can be used to determine the spinal cord level of the feeding artery and thus limit the amount of time it takes to perform the DSA procedure.

The present surgical treatment options include open surgical ligation or resection of the malformation, endovascular occlusion, spinal radiation, or a combination of these techniques.

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Case Information

rID: 33920
Case created: 29th Jan 2015
Last edited: 31st Jan 2015
Inclusion in quiz mode: Included

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