Case Of Spinal Arteriovenous Malformation Research Articles

O-014 initial mri diagnosis in 132 cases of angiographically confirmed spinal vascular malformations

Purpose To evaluate the accuracy of MRI for the diagnosis of spinal vascular malformations (SVM). Materials and methods We reviewed 133 consecutive patients with 142 high-flow SVMs confirmed by spinal angiography between 1999 and 2104. The initial MRI diagnosis was available in 132 instances. MRI was considered positive when a SVM was listed in the differential diagnosis or when spinal angiography was recommended. It was considered falsely negative otherwise (i.e., no or wrong diagnoses). The lesions included 89 spinal dural or epidural arteriovenous fistulas (SDAVF/SEAVF) (67.4%), 26 perimedullary arteriovenous fistulas (PmAVF) (19.7%), 8 spinal arteriovenous malformations (SAVM) (6.1%), 3 SAVM/PmAVFs (2.3%), and 6 paravertebral arteriovenous fistulas (ParAVF) (4.5%). The PmAVFs were subdivided into 8 Type 1 (6.1%), 15 Type 2 (11.4%), and 3 Type 3 (2.3%). Results The initial MRI diagnosis was falsely negative in 50% of cases (66 SVMs in 63 patients). Missed lesions included 54 SDAVF/SEAVFs (81.8%) and 12 PmAVFs (18.2%). No case of SAVM, SAVM/PmAVF, or ParAVF was missed. When grouped, slow-flow lesions (54 SDAVF/SEAVFs and 8 PmAVF Type 1) accounted for 93.9% of the false negative MRIs, with a 63.9% false negative ratio (62 missed lesions out of 97). The most common MRI misdiagnoses included inflammatory conditions (transverse myelitis) (46.0%), spine degenerative disease (11.1%), tumors (7.9%), and stroke (3.2%). No specific diagnosis was offered in 31.7% of cases. Conclusion The initial MRI in patients with SVMs was falsely negative in half of the reviewed cases. Slow-flow spinal arteriovenous fistulas (SDAVF, DEAVF, and PmAVF Type 1) were particularly insidious lesions, missed in about two-thirds of instances. About half the patients received an incorrect diagnosis of TM and were threated accordingly. Most patients with no specific MRI diagnosis were treated empirically for TM as well. Missed initial diagnoses not only delay adequate treatment for conditions with narrow therapeutic windows, but also result in the introduction of inappropriate, often deleterious management (e.g., high-dose steroids or plasma exchange). Our findings, based on patients with angiographically confirmed lesions, likely underestimate the true rate of false-negative MRI diagnoses in patients with SVMs. Disclosures D. Sorte: None. E. Wyse: None. E. Orru9: None. P. Gailloud: None.

Limb Hypertrophy and Urinary Retention in Parkes Weber: A Case Report

Vascular malformations are developmental abnormalities of the vascular system, which may involve any part of the vascular tree: arteries, veins, or capillaries. Patients with Parkes Weber have been found to have large arteriovenous malformations (AVM). We present a rare case of spinal AVM in a patient was newly diagnosed Parkes Weber syndrome. A 21-year-old male presented with worsening back pain with urinary retention and hypertrophied right lower limb. He was found to have a large spinal AVM with multiple AVMs in his right lower extremity. He was treated with surgical resection of his spinal AVM. Intraoperative angiography confirmed gross total resection of AVM. The patient was discharged from an acute rehab facility postoperative day fifteen without complications. The patient had two follow up since discharge and was found to have full strength and no urinary retention. It is important to recognize this rare disorder for prompt treatment to prevent further progression of symptoms.

Spinal Arteriovenous Malformation Masquerating Zoster Sine Herpete

Zoster sine herpete (ZSH) is difficult to diagnosis during an acute period due to the absence of the characteristic zosteriform dermatomal rash; therefore, progression to postherpetic neuralgia is more common than typical zoster. In addition, misdiagnosis of other neuropathic pain as ZSH is common in clinical situations. Here, we report a case of spinal arteriovenous malformation that mimics ZSH. This is a rare condition; therefore, high clinical suspicion for a correct diagnosis and proper examination are not easy. However, early diagnosis and definitive treatment are essential to prevent neurologic deficit and mortality.

Paraplegia in Pregnancy

A case report. To present improvement of paraplegia due to spinal vascular malformation after delivery with no intervention. Pregnancy has been reported rarely in patients with Klippel-Trenaunay syndrome (KTS). A combined case of spinal arteriovenous malformations (AVMs) within KTS has not been reported before. A case report of KTS with paraplegia is presented and the pertinent literature is then reviewed. A pregnant woman who was diagnosed with KTS in childhood presented with newly developed paraplegia due to spinal AVMs. Magnetic resonance image showed a vascular malformation at the T9-T12 levels without evidence of spinal cord hemorrhage. Diagnostic angiography that was performed after delivery revealed a high-flow arteriovenous fistula with AVM. Pregnancy complicated by paraplegia is thought to be secondary to venous engorgement and to the resulting spinal cord ischemia in this case. Her neurological symptoms and signs gradually improved over the few days after cesarean delivery.

Clinical application and diagnostic value of non-invasive spinal angiography in spinal vascular malformations

Objective To explore the value of CT spinal angiography with 256 MSCT and fast dynamic contrast-enhanced 3D MR angiography (CE-MRA) at 3.0 T in the diagnosis of spinal vascular malformations by comparing with results of DSA and operation.Methods Seventeen patients suspected of spinal vascular diseases by initial MR and clinical manifestations all underwent CT spinal angiography.Of them,10 patients underwent MRA,15 patients underwent DSA within 3-5 days,and 8 patients finally underwent surgical treatment.Results CTA examination clearly showed the abnormal vascular lesions in 16 of 17 cases,including 7 cases with the diagnosis of spinal dural arteriovenous fistula,7 cases of perimedullary arteriovenous fistula,and 2 cases of spinal arteriovenous malformations. The results were consistent with the diagnosis of DSA or surgery.One case was poorly diagnosed.The feeding vessels were correctly determined in 12 cases,and the level of fistulas were correctly displayed in 12 cases.The level of fistulas and feeding vessels were accurately showed in 7 of 10 cases with MRA,while the other 3 cases exhibited normal with DSA.Conclusions Spinal angiography with 256 MSCT and CE-MRA at 3.0 T can clearly show the extent of spinal vascular malformations,feeding arteries and fistula location.They are safe,noninvasive,convinient and can shorten the time of DSA diagnosis and treatment.They play an important role in diagnosis and treatment of spinal vascular malformations and postoperative follow-up. Key words: Spinal cord vascular diseases; Magnetic resonance imagiag; Tomography, X-ray computed; Angiography,digital subtraction

Spinal arteriovenous malformation presenting as spastic monoplegic cerebral palsy in a child

A case of spinal arterio-venous malformation (AVM) initially diagnosed as unilateral cerebral palsy (CP) is reported. The presentation was of a long-standing spastic monoparesis of the left leg, with initial response to Botulinum toxin injections to the calf and tibialis posterior muscles. This was followed by progressive deterioration occurring over a 3-month period before further investigation and definitive diagnosis at 7 years. Imaging demonstrated a large extra-medullary spinal AVM compressing the mid-thoracic cord. This was successfully managed by embolisation with a non-adhesive polymer: ethylene-vinyl alcohol copolymer injected into the dominant feeding vessel. This case highlights the need to consider alternative diagnoses when a child with a diagnosis of CP presents with atypical clinical features such as monoparesis and has worsening or altered clinical signs. Moreover, a normal magnetic resonance imaging brain scan and the absence of ipsilateral upper limb neurological signs or functional impairment should raise suspicion even in the context of static lower limb signs. A literature review was performed on the management of spinal AVM in children and this will be is discussed.

Cobbs syndrome: A case of spinal arteriovenous malformation treated with endovascular embolization

Cobb syndrome is a rare illness that combines vascular skin nevus and spinal vascular malformation at the same metamere. We report the case of a 34-year old man that presented a light low back pain, a slowly progressive paraparesis and abnormal urinary sphincter functioning. MR imaging of the thoracic spine depicted an intramedular arteriovenous malformation. Spinal angiography confirmed these findings. The arteriovenous malformation also affected the chestwall bones and muscles with the same metameric distribution as the intramedular lesion. Due to these findings Cobb syndrome was suspected and in a second physical examination a skin angioma was noted on the patient's back. He was treated with corticosteroids and endovascular coiling and his symptoms rapidly improved. Although pathophysiology of this syndrome is poorly understood and the correct management remains unknown, endovascular treatment has become the first choice for spinal arteriovenous malformations. We believe that combined treatment with corticosteroids and endovascular embolization is an effective procedure to alleviate symptoms and to minimize morbidity.

A Case of Spinal Arterio-venous Malformation with Severe Neuropathic Pain in the Back and Lower Extremities that Persisted after Embolization

A Case of Spinal Arterio-venous Malformation with Severe Neuropathic Pain in the Back and Lower Extremities that Persisted after Embolization

CT angiography with multidetector-row helical CT in spinal arteriovenous malformation

We performed intravenous CT angiography using multidetector-row helical computed tomography (MDCT) in a 63-year-old man with spinal arteriovenous malformation (AVM). The CT angiography demonstrated feeding arteries, varix-like structure, draining veins and their relationship to the spinal cord. Although selective angiography is essential in planning treatment for spinal AVMs as well as in establishing the diagnosis of the disease, CT angiography can be a good supplementary technique for visualizing precise location of abnormal vessels in a certain case of spinal AVM.

Spinal arteriovenous malformations: a personal review

This is a review of my personal series of 76 operated cases of spinal arteriovenous malformations. The anatomy of the lesions in my series is compared to other large series, including the National Institutes of Health study of 81 cases, Symon's 60 cases, Pia's 161 cases and Berenstein's 81 cases. My personal opinions regarding the etiology and pathophysiology of these lesions is presented. My progressive changes in approach to diagnosis and treatment over the 25-year period are reviewed, as are the results.

脊髄脊髄動静脈奇形の診断と治療

We report four cases of spinal arteriovenous malformations. While MRI was useful for making an early diagnosis, selective angiography was necessary for the final diagnosis. Embolization was performed in 2 cases, feeder ligation in one case, and another case underwent extraction. Excellent results were achieved in all cases.

Discrepancy between provocative test and clinical results following endovascular obliteration of spinal arteriovenous malformation

We report a case of spinal arteriovenous malformation with no signs of neurological deterioration after transarterial embolization, although the results of a provocative test with injection of lidocaine was positive on monitoring of clinical findings and somatosensory-evoked potentials (SEPs). We discussed the possible overestimation by the provocative test, and the limitations of SEP monitoring during endovascular surgery

Arteriovenous malformation of the spinal cord

We report a case of spinal arteriovenous malformation (AVM) in which detailed morphological examination of the intramedullary vascular lesion was carried out employing serial section studies. The relationship of the malformation to parenchymal lesions was evaluated. An abnormal vessel at the spinomedullary transition, whose lamina elastica was partially interrupted, was suggestive of a shunt vessel. The location of the intramedullary abnormal vessels and foci of softening of the spinal cord almost overlapped in distribution. Three-dimensional reconstruction of the intramedullary abnormal vessels demonstrated marked elongation and tortuosity of the original vascular architecture and they ended in the extramedullary abnormal vessels with thickened wall. Thus, our study showed that the intramedullary abnormal vessels were the result of secondary changes subsequent to pressure and volume overload inflicted upon the spinal venous system through AVM. Compression by tortuous elongation of the intramedullary vessels is the apparent cause of the parenchymal softening. A traumatic factor in the aetiology of the AVM was also discussed, since the patient had had two preceding episodes of traffic accidents with cranial and lumbar injury. Trauma seemed to be significant factor as a trigger of symptoms.