scholarly journals Spinal Arteriovenous Epidural Fistula with Acute Paraplegia

2007 ◽  
Vol 13 (1) ◽  
pp. 75-78 ◽  
Author(s):  
J. Reul ◽  
V. Braun
Keyword(s):  
Spinal Cord ◽  
Emergency Management ◽  
Arteriovenous Fistula ◽  
Emergency Treatment ◽  
Venous Congestion ◽  
Neurological Deficits ◽  
Spinal Angiography ◽  
Acute Paraplegia ◽  
Vascular Myelopathy

We report a case of a 68-year-old woman with an acute paraplegia due to venous congestion of the spinal cord caused by an exclusive epidural arteriovenous fistula. Diagnosed by MRI and selective spinal angiography the fistula was embolized during emergency treatment via transarterial access. Immediately after the intervention the paraplegia declined and the patient recovered completely. Epidural AV fistulae are a very rare and therefore relatively unknown cause of vascular myelopathy. They may require emergency management to avoid permanent neurological deficits.

Transvertebral Transposition of the Spinal Cord for Recovery of Motor Evoked Potentials and Somatosensory Evoked Potentials After Acute Paraplegia During Kyphoscoliosis Surgery: Technique Note, Case Reports and Literature Review

2020 ◽  
Author(s):  
Chao Chen ◽  
Jing Li ◽  
Bingjin Wang ◽  
Lingwei Zhu ◽  
Yong Gao ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Somatosensory Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Case Reports ◽  
Deformity Correction ◽  
Neurological Deficits ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Acute Paraplegia

Abstract Background: Neurological impairment during spinal deformity surgery was the most serious complication. When confronting intraoperative neurophysiological monitoring alerts, various surgical management methods such as the release of implants and decompression of the spinal cord are always performed. Transvertebral transposition of the spinal cord is rarely performed, and its role in the management of acute paraplegia is seldom reported.Methods: The authors present two patients with kyphoscoliosis experienced intraoperatively or postoperatively neurological deficits and abnormal neurological monitoring was detected during correction surgery. Acute paraplegia was confirmed by a wake-up test. Subsequent spinal cord transposition was performed. Intraoperative neurophysiological monitoring motor evoked potentials (MEP) and somatosensory evoked potentials (SEP) was performed to detect the changes during the process.Results: After transvertebral transposition of the spinal cord, the MEPs and SEPs were significantly improved in both patients during surgery. The spinal cord function was restored postoperatively and recovered to normal at the final follow-up in two patients. Conclusions： This case demonstrated that instead of decreasing the correction ratio of kyphoscoliosis, transvertebral transposition of the spinal cord under intraoperative neurophysiological monitoring could be an effective therapeutic strategy for acute spinal cord dysfunction caused by deformity correction surgeries.

Diagnosis and Evaluation of Acute Paraplegia

1983 ◽  
Vol 4 (10) ◽  
pp. 327-330
Author(s):  
John M. Freeman
Keyword(s):  
Spinal Cord ◽  
Differential Diagnosis ◽  
Adolescent Girl ◽  
Emergency Treatment ◽  
Sudden Onset ◽  
Loss Of Function ◽  
Irreversible Damage ◽  
Spinal Cord Disease ◽  
Acute Paraplegia ◽  
The Brain

CASE REPORT A 14-year-old high school student is admitted to the pediatric neurology service because of the sudden onset of inability to use her legs. When she had gotten up in the morning she was unable to stand. INTRODUCTION Acute neurologic deficit in an adolescent girl (or in anyone else) always represents an emergency requiring immediate evaluation by a physician competent to analyze the deficit, localize its source, develop a differential diagnosis of possible etiologies, organize appropriate tests, and, when indicated, initiate emergency treatment. Acute paraplegia (weakness or paralysis in the legs) is a particular emergency because acute compressive lesions of the cord are reversible. Hours of compression may result in irreversible damage. For this reason neurologic and neurosurgical consultation should be obtained promptly. EVALUATION The evaluation of an individual with an acute paraplegia is best performed with a differential diagnosis in mind. The major cause of paraplegia is spinal cord disease, and its differential diagnosis is shown in Table 1. Spinal cord disease with paraparesis (weakness) may be simulated by lesions in the parasagittal area of the brain, by muscle weakness in the legs (muscular dystrophy or polymyositis), and by conversion reaction. History In evaluating the patient with an "acute" paraplegia one must establish how acute is acute. An immediate total loss of function is almost always vascular.

scholarly journals Metachronous Multiplicity of Spinal Cord Arteriovenous Fistula and Spinal Dural AVF in a Patient with Hereditary Haemorrhagic Telangiectasia

2005 ◽  
Vol 11 (1) ◽  
pp. 79-82 ◽  
Author(s):  
J.C.M. Ling ◽  
R. Agid ◽  
S. Nakano ◽  
M.P.S. Souza ◽  
G. Reintamm ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Arteriovenous Fistula ◽  
Autosomal Dominant ◽  
Clinical Presentation ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Spinal Angiography ◽  
Spinal Dural Avf ◽  
Spinal Avm

HHT (Hereditary Haemorrhagic Telangiectasia or Rendu Osler Weber disease) is a known autosomal dominant dysplasia. The first clinical presentation of HHT in a child may be a cerebral or spinal AVM. We present the case of a young boy with HHT who had a previous spinal cord AVF treated by surgical obliteration and then presented with a spinal dural AVF nine months later. This patient had surgical obliteration of a spinal cord perimedullary AVF and subsequently developed a new spinal dural AVF at a different level. The diagnosis was made by spinal MR imaging and spinal angiography

Myelopathy due to intracranial dural arteriovenous fistula: a potential diagnostic pitfall

2011 ◽  
Vol 114 (3) ◽  
pp. 830-833 ◽  
Author(s):  
Nam-Hee Kim ◽  
Keun-Tae Cho ◽  
Hyung Suk Seo
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Demyelinating Disease ◽  
Clinical Manifestations ◽  
Transverse Myelitis ◽  
Cervical Cord ◽  
Diagnostic Pitfall ◽  
Life Threatening ◽  
Vascular Myelopathy

Intracranial dural arteriovenous fistula (DAVF) is rare and potentially life-threatening disease often presenting as vascular myelopathy. The early and proper diagnosis is challenging because the clinical manifestations are related to the distribution of the draining vein, not the fistula site, and imaging findings are similar to demyelinating disease of the spinal cord. The authors present the case of a 45-year-old man who developed acute progressive quadriplegia and respiratory difficulty with an enhancing, longitudinally extensive cervical cord lesion. These symptoms were highly suspicious for transverse myelitis but were caused by an intracranial DAVF. Intracranial DAVF with venous reflux to the brainstem and spinal cord is a rare but important differential diagnosis of progressive worsening myelopathy that is treatment resistant and gives the diagnostic impression of transverse myelitis.

Arteriovenous fistula and pseudoaneurysm of the anterior spinal artery caused by an epidural needle in a 5-year-old patient

2013 ◽  
Vol 11 (3) ◽  
pp. 340-345 ◽  
Author(s):  
Ibrahim Alnaami ◽  
Fred C. Lam ◽  
Graham Steel ◽  
Bryan Dicken ◽  
Cian J. O'Kelly ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Neurological Deficits ◽  
Anterior Spinal Artery ◽  
Epidural Needle ◽  
Needle Stick Injury ◽  
Neuraxial Blockade ◽  
Spinal Arteriovenous Fistula ◽  
Cord Injury ◽  
Repeat Angiography

Authors present the case of a 5-year-old patient with a spinal arteriovenous fistula (AVF) and pseudoaneurysm of the anterior spinal artery (ASA) caused by a traumatic epidural needle stick injury. A discussion and relevant review of the literature follow. The boy had a remote history of a liver transplant and required neuraxial blockade for an unrelated abdominal surgical procedure. Initial insertion of the epidural needle at the T9–10 interspace yielded blood. A second attempt at T10–11 was successful. Delayed left leg weakness developed on postoperative Day 8, with an MR image showing a track injury through the cord and a ventral subarachnoid hematoma. Laminectomies from T-9 to T-11were performed emergently to decompress the spinal cord. The dura mater was opened, the ventral hematoma was evacuated, and brisk venous bleeding was controlled with cauterization. Postoperative spinal angiography demonstrated an AVF and pseudoaneurysm of the ASA. Repeat angiography at postoperative Week 4 demonstrated complete resolution of the AVF and pseudoaneurysm, probably due to intraoperative cauterization of the draining vein. The patient underwent a short course of rehabilitation and had no clinical or electrophysiological evidence of spinal cord damage at the 20-month follow-up. One should be cognizant of the possibility of a cord injury in a patient with new-onset neurological deficits following an interventional spine procedure. Neuroimaging is essential for prompt diagnosis and treatment.

β-Mannosidosis: Myelin and oligodendrocyte lesions in brain and spinal cord

1984 ◽  
Vol 42 ◽  
pp. 694-695
Author(s):  
Kathryn L. Lovell ◽  
Margaret Z. Jones
Keyword(s):  
Spinal Cord ◽  
Nervous System ◽  
Genetic Disorder ◽  
Neurological Deficits ◽  
Axonal Spheroids ◽  
South Wales ◽  
Pendular Nystagmus ◽  
Myelin Deficits ◽  
Recessive Defect ◽  
Brain And Spinal Cord

Caprine β-mannosidosis, an autosomal recessive defect of glycoprotein catabolism, is associated with a deficiency of tissue and plasma -mannosidase and with tissue accumulation and urinary excretion of oligosaccharides, including the trisaccharide Man(β1-4)GlcNAc(βl-4)GlcNAc and the disaccharide Man(β1-4)GlcNAc. This genetic disorder is evident at birth, with severe neurological deficits including a marked intention tremor, pendular nystagmus, ataxia and inability to stand. Major pathological characteristics described in Nubian goats in Michigan and in Anglo-Nubian goats in New South Wales include widespread cytoplasmic vacuolation in the nervous system and viscera, axonal spheroids, and severe myelin paucity in the brain but not spinal cord or peripheral nerves. Light microscopic examination revealed marked regional variation in the severity of central nervous system myelin deficits, with some brain areas showing nearly complete absence of myelin and other regions characterized by the presence of 25-50% of the control number of myelin sheaths.

Impairment Tutorial: Neurological Impairment Evaluation: Overview of Sixth Edition Approaches

2008 ◽  
Vol 13 (2) ◽  
pp. 6-8
Author(s):  
Lorne Direnfeld ◽  
Christopher R. Brigham ◽  
Elizabeth Genovese
Keyword(s):  
Spinal Cord ◽  
Neurological Impairment ◽  
Diagnostic Techniques ◽  
Neurological Deficits ◽  
Sixth Edition ◽  
Pain Disability ◽  
Whole Person ◽  
Disability Questionnaire ◽  
Cervical Plating

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), does not provide a Diagnosis-based estimate of impairment due to syringomyelia, a disorder in which a cyst (syrinx), develops within the central spinal cord and destroys neural tissue as it expands. The AMA Guides, however, does provide an approach to rating a syringomyelia based on objective findings of neurological deficits identified during a neurological examination and demonstrated by standard diagnostic techniques. Syringomelia may occur after spinal cord trauma, including a contusion of the cord. A case study illustrates the rating process: The case patient is a 46-year-old male who fell backwards, landing on his upper back and head; over a five-year period he received a T5-6 laminectomy and later partial corpectomies of C5, C6, and C7, cervical discectomy C5-6 and C6-7; iliac crest strut graft fusion of C5-6 and C6-7; and anterior cervical plating of C5 to C7 for treatment of myelopathy; postoperatively, the patient developed dysphagia. The evaluating physician should determine which conditions are ratable, rate each of these components, and combine the resulting whole person impairments without omission or duplication of a ratable impairment. The article includes a pain disability questionnaire that can be used in conjunction with evaluations conducted according to Chapter 3, Pain, and Chapter 17, The Spine.

Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Nur Setiawan Suroto
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Vascular Malformation ◽  
Dural Arteriovenous Fistula ◽  
Motor Symptoms ◽  
Elderly Men ◽  
Spinal Dural Arteriovenous Fistula ◽  
Sensory Disturbances ◽  
Av Fistulas ◽  
Low Rate

Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region.Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances.

Clipping of an anterior spinal artery aneurysm using an endoscopic fluorescence imaging system for craniocervical junction epidural arteriovenous fistula: technical note

2019 ◽  
Vol 31 (2) ◽  
pp. 279-284 ◽  
Author(s):  
Ahmed Mansour ◽  
Toshiki Endo ◽  
Tomoo Inoue ◽  
Kenichi Sato ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Fluorescence Imaging ◽  
Imaging System ◽  
Artery Aneurysm ◽  
Craniocervical Junction ◽  
Anterior Spinal Artery ◽  
Posterolateral Approach ◽  
Fluorescence Imaging System ◽  
Ventral Spinal Cord

The authors report the case of a 78-year-old man with a craniocervical junction epidural arteriovenous fistula who presented with subarachnoid hemorrhage from a ruptured anterior spinal artery (ASA) aneurysm. Because endovascular embolization was difficult, a posterolateral approach was chosen and a novel endoscopic fluorescence imaging system was utilized to clip the aneurysm. The fluorescence imaging system provided clear and magnified views of the ventral spinal cord simultaneously with the endoscope-integrated indocyanine green videoangiography, which helped safely obliterate the ASA aneurysm. With the aid of this novel imaging system, surgeons can appreciate and manipulate complex vascular pathologies of the ventral spinal cord through a posterolateral approach, even when the lesion is closely related to the ASA.

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