Intramedullary Hemorrhage Research Articles

Endothelin-1 Immunoreactivity and its Association with Intramedullary Hemorrhage and Myelomalacia in Naturally Occurring Disk Extrusion in Dogs.

BackgroundThe pathophysiology of ascending/descending myelomalacia (ADMM) after canine intervertebral disk (IVD) extrusion remains poorly understood. Vasoactive molecules might contribute.Hypothesis/ObjectivesTo investigate the immunoreactivity of endothelin‐1 (ET‐1) in the uninjured and injured spinal cord of dogs and its potential association with intramedullary hemorrhage and extension of myelomalacia.AnimalsEleven normal control and 34 dogs with thoracolumbar IVD extrusion.MethodsSpinal cord tissue of dogs retrospectively selected from our histopathologic database was examined histologically at the level of the extrusion (center) and in segments remote from the center. Endothelin‐1 immunoreactivity was examined immunohistochemically and by in situ hybridization. Associations between the immunoreactivity for ET‐1 and the severity of intramedullary hemorrhage or the extension of myelomalacia were examined.ResultsEndothelin‐1 was expressed by astrocytes, macrophages, and neurons and only rarely by endothelial cells in all dogs. At the center, ET‐1 immunoreactivity was significantly higher in astrocytes (median score 4.02) and lower in neurons (3.21) than in control dogs (3.0 and 4.54) (P < .001; P = .004) irrespective of the grade of hemorrhage or myelomalacia. In both astrocytes and neurons, there was a higher ET‐1 immunoreactivity in spinal cord regions remote from the center (4.58 and 4.15) than in the center itself (P = .013; P = .001). ET‐1 mRNA was present in nearly all neurons with variable intensity, but not in astrocytes.Conclusion and Clinical ImportanceEnhanced ET‐1 immunoreactivity over multiple spinal cord segments after IVD extrusion might play a role in the pathogenesis of ADMM. More effective quantitative techniques are required.

Value of susceptibility - weighted imaging in detecting in intramedullary hemorrhage in traumatic acute spinal cord injury

Objective To evaluate the clinical value of susceptibility- weighted imaging(SWI) in detecting intramedullary hemorrhage of traumatic acute spinal cord injury. Methods From October 2012 to December 2014, 37 TSCI (traumatic spinal cord injuries) patients undergone the MRI scans including routine MRI and SWI were enrolled. Further according to ASIA classification standard, all patients were evaluated as ASIA A (n=4), ASIA B (n=4), ASIA C (n=19) and ASIA D (n=10). Referring to axial T2WI images at the same slice, the manifestations of hemorrhage in amplitude image, phase image and SWI were evaluated. At the slice with maximal size of hemorrhage area and its neighboring slices, the hemorrhage regions were manually drawn; and the total area was automatically calculated. The number of hemorrhage lesions was defined as the number of hemorrhage lesions at single slice × slice number. One-way ANOVA was used to compare the differences among different grading ASIA in terms of hemorrhage area and number. Meanwhile, the relations between hemorrhage area and ASIA grade; hemorrhage number and ASIA grade were evaluated by Spearman rank correlation. Results The hemorrhage was detected by SWI in 15 patients, including 4 ASIA A, 4 ASIA B, 7 ASIA C. Hemorrhage represents as isointense in T1WI and a slightly low signal intensity or isointense in the center companied by high intensity at circus in T2WI. In magnitude image and SWI hemorrhage appears as low signal intensity and low signal intensity in the center companied by high intensity at circus in phase image. In detecting the hemorrhage, SWI (98 lesions were detected) was 5.4 times of T2WI (19 lesion were detected). As for the number of hemorrhage, significant differences were found among ASIA grading A, B and C (grading A: 22.5±1.3, grading B: 19.5±1.3, grading C: 4.0±1.1; F= 38.720, P<0.01); Further the pairwise comparison showed statistical significance (P<0.05); besides, the number of hemorrhage lesions closely related with the ASIA grade (r=0.864, P<0.01). For the hemorrhage area, the calculated results of grading ASIA A, B and C were (23.5 ± 0.6), (21.8 ± 1.9), (3.9 ± 0.7) mm2, respectively; there were significant differences among the different ASIA grades (F=29.987, P<0.001); furthermore the hemorrhage area also showed closely relation with the ASIA grade (r=0.778, P<0.01). Conclusions SWI is more sensitive in detecting the hemorrhage in traumatic acute spinal cord injury. The more number and area of bleeding area suggest the more severe of the damage level. Key words: Spinal cord injuries; Magnetic resonance imaging; Hemorrhage

Chapter 37 - Imaging of trauma of the spine

The goal of imaging in spine trauma is to gauge the extent of bony, vascular, and neurologic compromise. Neurologic and mechanical stability are key pieces of information that must be efficiently communicated to the referring clinician. From immobilization and steroid therapy, to vascular repair and emergent surgical intervention, clinical outcomes of spine-injured patients depend on timely and well-chosen imaging studies. Multidetector computed tomography (CT) has essentially replaced radiography in clearance of the spine and is the gold standard in evaluation of the bony spinal column. Magnetic resonance imaging (MRI) is typically reserved for patients with neurologic deficits or for obtunded/impaired patients in whom the neurologic exam is not reliable, even in the absence of osseous injury on CT. MRI is the only available imaging modality that is able to clearly depict the internal architecture of the spinal cord, and, as such, has a central role in depicting parenchymal changes resulting from injury. Intramedullary edema and hemorrhage have been shown to correlate with the degree of neurologic deficit and prognosis. Moreover, advanced MRI techniques, such as diffusion and diffusion tensor imaging, have shifted the focus to determining structural and functional integrity of neural structures. Here, we review the role of imaging in spine trauma, as well as the key radiologic features of injury to the spinal column and spinal cord.

Acute Paraplegia due to Thoracic Hematomyelia.

Spontaneous intraspinal intramedullary hemorrhage is a rare entity with the acute onset of neurologic symptoms. The etiology of idiopathic spontaneous hematomyelia (ISH) is unknown, and there are few published case reports. Hematomyelia is mostly associated with trauma, but the other nontraumatic etiologies are vascular malformations, tumors, bleeding disorders, syphilis, syrinx, and myelitis. MRI is a good choice for early diagnosis. Hematomyelia usually causes acute spinal cord syndrome due to the compression and destruction of the spinal cord. A high-dose steroid treatment and surgical decompression and evacuation of hematoma are the urgent solution methods. We present idiopathic spontaneous hematomyelia of a previously healthy 80-year-old male with a sudden onset of back pain and paraplegia.

Relationship between magnetic resonance imaging findings and spinal cord injury in extension injury of the cervical spine

The purpose of this study was to determine the relationship between magnetic resonance imaging (MRI) findings and neurologic symptoms in cervical spine extension injury and to analyze the MRI parameters associated with neurologic outcome. This study included 102 patients with cervical spine extension injury, whose medical records and MRI scans at the time of injury were available. Quantitative MRI parameters such as maximum spinal canal compression (MSCC), maximum cord compromise (MCC), and lesion length showing intramedullary signal changes were measured. Furthermore, intramedullary hemorrhage, spinal cord edema, and soft tissue damage were evaluated. Fisher's exact test was used for a cross-analysis between the MRI findings and the three American Spinal Injury Association category groups depending on the severity level of neurologic injury: complete (category A), incomplete (categories B-D), and normal (category E). MSCC accounted for 23.05, 19.5, and 9.94% for the complete, incomplete, and normal AIS categories, respectively, without showing statistically significant differences (P=0.085). MCC was noted in 22.05, 15.32, and 9.2%, respectively, with the complete-injury group (AIS category A) showing significantly higher. In particular, cases of complete injury had >15% compression, accounting for 87.5% (P<0.001). The mean intramedullary lesion length was significantly higher in complete-injury patients than in incomplete-injury patients (24.22 vs. 8.24mm). Intramedullary hemorrhage and spinal cord edema were significantly more frequently observed in complete-injury cases (P<0.001). The incidence of complete injury was proportional to the severity of soft tissue damage. MCC, intramedullary lesion length, intramedullary hemorrhage, and spinal cord edema were MRI parameters associated with poor neurologic outcomes in patients with cervical spine extension injury.

Longitudinal extension of myelomalacia by intramedullary and subdural hemorrhage in a canine model of spinal cord injury

Background ContextIn canine intervertebral disc (IVD) extrusion, a spontaneous animal model of spinal cord injury, hemorrhage is a consistent finding. In rodent models, hemorrhage might be involved in secondary tissue destruction by biochemical mechanisms. PurposeThis study aimed to investigate a causal association between the extents of intramedullary, subdural and epidural hemorrhage and the severity of spinal cord damage following IVD extrusion in dogs. Study Design/SettingA retrospective study using histologic spinal cord sections from 83 dogs euthanized following IVD extrusion was carried out. MethodsThe degree of hemorrhage (intramedullary, subdural, epidural), the degree of spinal cord damage in the epicenter (white and gray matter), and the longitudinal extent of myelomalacia were graded. Associations between the extent of hemorrhage and the degree of spinal cord damage were evaluated statistically. ResultsIntramedullary and subdural hemorrhages were significantly associated with the degree of white (p<.001/ p=.004) and gray (both p<.001) matter damage, and with the longitudinal extension of myelomalacia (p<.001/p=.005). Intriguingly, accumulation of hemorrhagic cord debris inside or dorsal to a distended and ruptured central canal in segments distant to the epicenter of the lesion was observed exhibiting a wave-like pattern on longitudinal assessment. The occurrence of this debris accumulation was associated with high degrees of tissue destruction (all p<.001). ConclusionsTissue liquefaction and increased intramedullary pressure associated with hemorrhage are involved in the progression of spinal cord destruction in a canine model of spinal cord injury and ascending or descending myelomalacia. Functional and dynamic studies are needed to investigate this concept further.

Radiosurgery for Spinal Intramedullary Arteriovenous Malformations: A Literature Review.

Intramedullary spinal cord arteriovenous malformations (SCAVMs) comprise only 3 to 4% of spinal cord pathologies and are often not amenable to total resection due to extensive involvement with spinal cord parenchyma and multiple arterial feeding vessels. A electronic database search from 1966 to February 28, 2014, was conducted for relevant articles using the keywords and Medical Subject Headings strings spinal arteriovenous malformation, spinal radiosurgery, spinal vascular malformation, and radiosurgery for vascular lesions. Target outcomes measures were nidus obliteration, neurologic improvement, and complication rate. Four retrospective articles containing a total of 30 patients were identified that described patients with SCAVMs presenting with symptomatic intramedullary or subarachnoid hemorrhage. Eighteen patients underwent treatment with CyberKnife with dosages ranging from 21 to 40 Gy (or a maximum biological equivalent dose of 58 Gy for early treatment effect) (Accuray, Inc., Sunnyvale, California, United States), 10 with a linear accelerator and real-time respiratory tracking ranging from 32 to 40 Gy, and 2 patients with external-beam radiotherapy receiving 45 Gy and 50 Gy, respectively. The mean time for clinical follow-up was 43.5 months (range: 27.9-60 months). There were no cases of spinal cord hemorrhage after radiosurgery. Nor were there any cases of neurologic worsening or signs and symptoms of neuropathic pain or myelitis. A total of 29 of the 30 patients obtained follow-up.

The durotomy or myelotomy for the spinal cord extensive swelling with/without intramedullary hemorrhage

Objective To evaluate the necessity and feasibility of durotomy or myelotomy for the spinal cord extensive swelling with/without intramedullary hemorrhage. Methods Data of 21 cases with spinal cord extensive swelling with/without intramedullary hemorrhage who underwent durotomy or myelotomy from January 2009 to September 2014 were retrospectively analyzed. There were 13 males and 8 females, with an average age of 39.1 (range, 13-69) years old. 16 cases had the situation of spinal fracture or dislocation, 9 cases had locked facet, and 12 cases had disc injury. The swelling locations of 18 cases were at cervical cord, and 3 at thoracolumbar cord. The swelling area of 17 cases were at 2-4 segments, and 4 cases over 4 segments. Results No wound infection, aggravated disk hernia, aggravated spinal cord injury, vertebral artery injury or aggravated disc injury happened in any cases. The MRI of two weeks after operation showed that the high signal of swelling disappeared in T2WI. According to the American Spinal Cord Injury Association (ASIA) Impairment Scale, 6 grade A cases were still grade A, but the feeling and movement improved obviously. 7 grade B cases improved to grade C, 2 grade B cases improved to grade D, and 1 grade B case improved to grade E. 4 grade C cases improved to grade D, and 1 grade C case improved to grade E. For the patients with intramedullary hemorrhage, 2 grade A cases were still grade A with improvement in feeling and movement, 1 grade B improved to grade C, 1 grade B improved to grade D, and 1 grade C improved to grade D. Conclusion For the patients with spinal cord extensive swelling with/without intramedullary hemorrhage, the durotomy or myelotomy is safe and efficacious which could relief the blockade of spinal epidural veins, arteriole of cord. It may also reduce the secondary injury, create conditions for improving breathing, circulating and rescuing the life, and it could be helpful for the recovery of spinal cord neurological function. Key words: Spinal cord injuries; Hematoma, subdural, spinal; Decompression, surgical

The durotomy or myelotomy for the spinal cord extensive swelling with/without intramedullary hemorrhage

Objective To study the shortterm clinical outcomes of unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis, and to compare 2 kinds of unicompartmental prosthesis. Methods From March 2010 to June 2013, data of 43 patients underwent unicompartmental knee arthroplasty (UKA) were retrospectively analyzed. 17 patients (17 knees) used rotating platform prosthesis, and 26 patients (28 knees) used fixed bearing prosthesis. There were 7 males (7 knees) and 9 females (10 knees) in rotating platform group, with an average age of 64.1 years (range, 54-82 years); while 10 males (10 knees) and 17 females (18 knees) in fixed bearing group, with an average age of 62.2 years (range, 43-79 years). All patients presented signs of narrowed medial joint space, medial tenderness and pain on weight-bearing. X-ray and MRI were used for documenting joint narrowing and cartilage defect. The pain and the knee functions were recorded both pre and post-operatively with knee society score (KSS), 2 cases of simultaneous anterior cruciate ligament (ACL) reconstruction were assessed with Tegner-Lysholm knee scoring scale as well. Results All 43 patients were followed up for 6 month to 37 months, and the average duration was 21.1 months. There were no dislocations, joint infection, deep venous thrombosis, prosthetic loosening, etc. The KSS in rotating platform group was 56.11±9.51 preoperatively, and 92.23±5.46 postoperatively. While the KSS in fixed bearing group was 57.11±9.56, and 93.69±6.37, respectively. There were statistical differences comparing between preoperative and postoperative KSS knee scores.There was no significant difference in KSS scores between rotating platform group and fixed bearing group. Conclusion Unicompartmental knee arthroplasty is a less invasive and effective method for knee osteoarthritis in medial compartment with less complications. There was no significant difference in clinical outcomes between rotating platform and fixed bearing design in terms of patients' satisfactory rate, clinical and functional outcomes in this shortterm followup study. Key words: Knee joint; Osteoarthritis; Arthroplasty, replacement, knee

A case of non-traumatic intramedullary spinal cord haemorrhage secondary to an arteriovenous malformation as a cause of painless myelopathy

A case of non-traumatic intramedullary spinal cord haemorrhage secondary to an arteriovenous malformation as a cause of painless myelopathy

Idiopathic Spontaneous Intramedullary Hemorrhage: A Report of a Rare Case of Repeated Intramedullary Hemorrhage with Unknown Etiology.

A 48-year-old woman presented with acute voiding difficulty, numbness and weakness of both lower extremities. Magnetic resonance imaging (MRI) showed an intramedullary hemorrhagic mass that extended from T9 to T10. T8-T10 laminotomy and surgical removal of the hemorrhagic mass was performed. The pathological diagnosis was hematoma. Her neurological status remained the same after the operation. At 5 days post-operation, the patient suddenly became paraplegic, and MRI that was immediately performed revealed a recurrent intramedullary hemorrhage. Emergent surgical evacuation was performed. Again, histological examination showed only hematoma, without any evidence of abnormal vessels or a tumor. A postoperative MRI revealed no abnormal lesions other than those resulting from postoperative changes. At a 9-month follow up, the patient could walk a short distance with the aid of a walker. Because spontaneous intramedullary hemorrhage with unknown etiology is very rare, it is essential to perform a meticulous inspection of the hemorrhagic site to find the underlying cause. Repeated hemorrhage can occur; therefore, close observation of patients after surgery is important in cases without an apparent etiology. Urgent surgical evacuation is important to improve outcomes in these cases.

Very high resolution ultrasound imaging for real-time quantitative visualization of vascular disruption after spinal cord injury.

Spinal cord injury (SCI) is characterized by vascular disruption with intramedullary hemorrhage, alterations in blood-spinal cord barrier integrity, and perilesional ischemia. A safe and easily applied imaging technique to quantify evolving intraspinal vascular changes after SCI is lacking. We evaluated the utility of very high resolution ultrasound (VHRUS) imaging to assess SCI-induced vascular disruption in a clinically relevant rodent model. The spinal cords of Wistar rats were lesioned at the 11th thoracic vertebra (Th11) by a 35 g 1-minute clip compression. Three-dimensional quantification of intraspinal hemorrhage using VHRUS (at an acute 90-min and subacute 24-h time point post-SCI) was compared with lesional hemoglobin and extravasated Evans blue dye measured spectrophotometrically. The anatomy of hemorrhage was comparatively assessed using VHRUS and histology. Time-lapse videos demonstrated the evolution of parenchymal hemorrhage. VHRUS accurately depicted the structural (gray and white matter) and vascular anatomy of the spinal cord (after laminectomy) and was safely repeated in the same animal. After SCI, a hyperechoic signal extended from the lesion epicenter. Significant correlations were found between VHRUS signal and hemorrhage in the acute (r=0.88, p<0.0001) and subacute (r=0.85, p<0.0001) phases and extravasated Evans blue (a measure of vascular disruption) in the subacute phase (r=0.94, p<0.0001). Time-lapse videos demonstrated that the expanding parenchymal hemorrhage is preceded by new perilesional hemorrhagic foci. VHRUS enables real-time quantitative live anatomical imaging of acute and subacute vascular disruption after SCI in rats. This technique has important scientific and clinical translational applications.

Spinal dural arteriovenous fistula with intramedullary cord hemorrhage

Spinal dural arteriovenous fistula (SDAVF) consists of an acquired arteriovenous shunt between a dural artery and perimedullary veins.1 This results in arterialization of radicular veins, venous hypertension, and decreased spinal cord perfusion.1 The condition has a male predominance and presents as a myelopathy in the fifth or sixth decade. Initial misdiagnosis is common.1–3 We present a man with a SDAVF and associated intramedullary cord hemorrhage.

Spinal dural arteriovenous shunt presenting with intramedullary hemorrhage

The authors report on a 49-year-old man with a thoracic spinal dural arteriovenous shunt (dAVS) in which rupture of a varix caused intramedullary hemorrhage. In the literature, patients with a thoracic dAVS predominantly present with congestive myelopathy; however, the patient featured in this report presented without increased deep tendon reflexes or muscle weakness, but instead with intermittent stabbing chest pain and paresthesia. Magnetic resonance images and angiograms demonstrated tortuous enlargement and the formation of a varix-like structure of the draining veins, features compatible with those of high-flow angiopathy. Recognition of this phenomenon is important in thoracic dAVS because intramedullary hemorrhage dramatically degrades outcome. A high index of clinical suspicion can prevent a similar case of thoracic dAVS from progressing to intramedullary hemorrhage.

Intramedullary Spinal Cord Hemorrhage Associated with Cardiac Ischemia

Intramedullary Spinal Cord Hemorrhage Associated with Cardiac Ischemia Intramedullary spinal cord hemorrhage (hematomyelia) is an uncommon cause of myelopathy. In this case, we reported a 22-year old female who presented with quadriplegia and neck pain.Spine MRI showed that the patient’s symptoms were secondary to intramedullary spinal cord hemorrhage in C1-C7. CT angiography revealed an earthworm-like cervical arteriovenous malformation originating from the right subclavian artery.

Ligaments disruption: a new perspective in the prognosis of spinal cord injury.

Ligaments disruption: a new perspective in the prognosis of spinal cord injury.

Sclerosing xanthofibroma of the rib that mimics a very aggressive malignant tumor of the thoracic wall.

Sclerosing xanthofibroma is a benign lesion generally of flat bones that is thought to be caused by a reactive response to intramedullary hemorrhage following chest wall trauma. We are reporting a case of a 56-year-old man that was complaining of a dump pain on the right back and a swelling right in this place for several weeks. The radiology was suggesting an aggressive malignant tumor of the chest wall and probably metastasis in both lungs meanwhile the patient was in good state and very active. The surgery was decisive for the diagnosis that, to the fortune of the patient, it was sclerosing xanthofibroma.

Multishot diffusion-weighted MR imaging features in acute trauma of spinal cord

To analyse diffusion-weighted MRI of acute spinal cord trauma and evaluate its diagnostic value. Conventional MRI and multishot, navigator-corrected DWI were performed in 20 patients with acute spinal cord trauma using 1.5-T MR within 72h after the onset of trauma. Twenty cases were classified into four categories according to the characteristics of DWI: (1) Oedema type: ten cases presented with variable hyperintense areas within the spinal cord. There were significant differences in the apparent diffusion coefficients (ADCs) between lesions and unaffected regions (t = -7.621, P < 0.01). ADC values of lesions were markedly lower than those of normal areas. (2) Mixed type: six cases showed heterogeneously hyperintense areas due to a mixture of haemorrhage and oedema. (3) Haemorrhage type: two cases showed lesions as marked hypointensity due to intramedullary haemorrhage. (4) Compressed type (by epidural haemorrhage): one of the two cases showed an area of mild hyperintensity in the markedly compressed cord due to epidural haematoma. Muti-shot DWI of the spinal cord can help visualise and evaluate the injured spinal cord in the early stage, especially in distinguishing the cytotoxic oedema from vasogenic oedema. It can assist in detecting intramedullary haemorrhage and may have a potential role in the evaluation of compressed spinal cord. • Multishot, navigator-corrected diffusion-weighted MRI is helpful when evaluating spinal cord injury (SCI). • Four types of SCI may be classified according to the DWI characteristics. • DWI differentiates cytotoxic from vasogenic oedema, thereby determining the centre of SCI. • DWI can assist in detecting intramedullary haemorrhage. • DWI can help evaluate the degree of compressed spinal cord.

Histological Effects of Residual Compression Sustained for 60 Minutes at Different Depths in a Novel Rat Spinal Cord Injury Contusion Model

Spinal cord injuries are frequently accompanied by persisting residual compression of the spinal cord; however, it remains controversial as to what effect the sustained compression has on neurological damage. The objective of this study was to determine the influence of post-traumatic residual spinal cord compression on the extent and progression of tissue damage within a dynamic thoracic contusion rat model. Twenty-nine male Wistar rats were distributed into one of four groups: spinal cord contusion only, contusion with 40% residual compression, contusion with 90% residual compression, and a surgical control group. A moderate injury was performed (1 mm, 700 mm/sec) with our custom University of British Columbia (UBC) multimechanism apparatus, and the residual compression groups had the impactor tip maintained at 40% or 90% of the initial impact depth (1.0 mm) for 60 min post-injury. All animals were killed at 3 h post-injury, when the spinal cord was harvested and stained for hemorrhage, neuronal damage in the gray matter, and axonal disruption in the white matter. The initial contusion injury immediately damaged tissue beneath the impactor as evidenced by rapid relaxation of the reaction force on the spinal cord during the subsequent compression. Importantly, the rostral-caudal extent of intramedullary hemorrhage was 66% larger after 90% residual spinal cord compression compared to the 40% group (p=0.016). Similarly, the extent of neuronal nuclei lost in different gray matter regions was 60-86% greater after 90% residual compression compared with 40% (p<0.001). Thus, a high level of residual compression of the spinal cord following a moderate contusion injury has the potential to adversely increase the extent of tissue damage, whereas a lower level of residual compression may have little to no effect.

Spontaneous Resolution of a Thoracic Spinal Epidural Arteriovenous Fistula Caused by Stabbing Injury

A single case is presented of a spontaneously resolving epidural arteriovenous fistula caused by a stab wound. To demonstrate a unique case of a spontaneously resolving epidural arteriovenous fistula caused by a stab wound, as well as to present a brief review of pathology. Spinal epidural arteriovenous fistulas (SEAVF) are high-flow vascular malformations characterized by an arteriovenous shunt involving the internal vertebral venous plexus (IVVP). SEAVFs can present with intramedullary, subarachnoid or epidural hemorrhages, spinal cord or nerve root compression, and progressive myelopathy secondary to medullary venous hypertension. The type of venous drainage (intradural, extradural, or mixed) strongly influences the mode of presentation. Spontaneous resolution of a spinal vascular malformation is a well-documented yet rare phenomenon. Angiographical and magnetic resonance images of the lesion were obtained pre- and post spontaneous resolution. A brief review of the topic is also presented. Our observation identifies stabbing as an unusual mechanism for the formation of a SEAVF, and offers an angiographically documented example of complete spontaneous resolution of this type of vascular malformation. SEAVFs of traumatic origin have been previously reported, but we believe that our observation represents the first documentation of such a lesion being caused by stabbing with subsequent spontaneous resolution. Spinal epidural arteriovenous fistulas (SEAVFs) are increasingly diagnosed vascular malformations with the potential to inflict serious neurological damage if not recognized and treated in time. Spontaneous resolution of a spinal vascular malformation is a well-documented yet rare phenomenon. Our observation identifies stabbing as an unusual mechanism for the formation of a SEAVF, and offers an example of complete spontaneous resolution of this type of vascular malformation.