Spinal vascular malformation in a 12 years old child. Diagnostic challenges and management strategies adopting a multidisciplinary approach.

Abstract

Background: Spinal vascular malformations (SVM) are a complex entity and rarely noted in children. They are commonly seen in the elderly with a predilection for the thoraco-lumbar region. The incidence varies from 3-11% and varies across all age groups. The presenting features in the initial stages are paraplegia, abnormal gait, paraesthesia, radicular pain and diffuse sensory symptoms. If not detected early they can lead to further spinal cord compression and cause urinary retention, bladder, bowel incontinence or erectile dysfunction. Despite the advances in diagnosis and treatment, the complexity of the pathology makes treatment challenging in a child.
 Case presentation: We present a 12 years old female child who presented with lower limb weakness, diminished reflexes and urinary retention. Nerve conduction velocity was suggestive of motor axonal neuropathy. Magnetic resonance imaging of spine was suggestive of paraspinal vascular malformation and has recovered after surgical intervention and embolization.
 Conclusion: Spinal vascular malformation is extremely rare in children with very few reported cases. A multi-disciplinary approach beginning with a detailed history taking and clinical examination is invaluable in such complicated cases to deal with the various aspects of a complex pathology.