Abstract
Background:Concurrent intracranial and spinal arteriovenous malformations (AVMs) are very rare with only a few cases being reported in literature. Two of the rare concurrent intracranial and spinal AVM cases are presented.Case Description:Case 1 is a 12-year-old girl with headache and motor disturbances in the lower limbs. Her spinal and brain angiogram was done and she was diagnosed to have a spinal AVM at level T8–T9 and an intracranial AVM in the left mesial temporal lobe. Her spinal AVM was embolized, while no treatment was given for her intracranial AVM. Case 2 is a 10-year-old girl who presented with headache and quadriparesis. Her brain and spinal angiogram revealed an intracranial AVM in the left parietal lobe and a spinal AVM at level C2, respectively. Craniotomy and excision was done for her intracranial AVM and embolization for the spinal AVM.Conclusion:It is proposed that multiple AVMs may be a result of yet unrevealed pathogenesis or strong embryogenetic anomaly, which may be different from that involved in single AVM. With lack of consensus over the best therapeutic strategy, multimodality treatment based on the individual's needs is suggested.
Highlights
Concurrent intracranial and spinal arteriovenous malformations (AVMs) are very rare with only a few cases being reported in literature
Single intracranial arteriovenous malformation (AVM) along with a spinal AVM is very rare with less than 10 cases being reported in literature since 1969
Multiple intracranial AVMs with a spinal AVM are even more infrequent; only three other cases have been reported in the literature, one being an autopsy case
Summary
It is proposed that multiple AVMs may be a result of yet unrevealed pathogenesis or strong embryogenetic anomaly, which may be different from that involved in single AVM. The first case of intracranial AVM along with a spinal AVM involves a 12-year-old girl who presented to us with a 3-month history of headache and progressively worsening spastic paraparesis with reflex spasms of both lower limbs. Brain imaging studies were done to investigate any intracranial pathology responsible for her persistent headache Her brain MRI and Magnetic Resonance Angiography (MRA) revealed a small AVM in the left hippocampus supplied by left posterior cerebral artery and with deep venous drainage [Figure 1b and c]. The second case of single intracranial AVM with concurrent spinal AV fistula involves a 10-year-old girl who presented to us with headaches and progressively increasing weakness of all four limbs for 21⁄2 years. After 1 year and 4 months, the patient showed signs of mild weakness in left-sided upper and lower limbs.
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