Metachronous spinal pial arteriovenous fistulas: case report

2020 ◽  
pp. 1-6
Author(s):  
Ramez N. Abdalla ◽  
Tahaamin Shokuhfar ◽  
Michael C. Hurley ◽  
Sameer A. Ansari ◽  
Babak S. Jahromi ◽  
...  
Keyword(s):  
Lower Extremity ◽  
De Novo ◽  
Vascular Lesion ◽  
Conus Medullaris ◽  
Perineal Pain ◽  
Conventional Angiography ◽  
Lower Extremity Weakness ◽  
Arteriovenous Fistulas ◽  
Type Iv ◽  
History Of

Spinal pial arteriovenous fistulas (spAVFs) are believed to be congenital lesions, and the development of a de novo spAVF has not been previously described. A 49-year-old female with a childhood history of vascular malformation–induced right lower-extremity hypertrophy presented in 2004 with progressive pain in her right posterior thigh and outer foot. Workup revealed 3 separate type IV spAVFs, which were treated by combined embolization and resection, with final conventional angiography showing no residual spinal vascular lesion in 2005. Ten years later, the patient returned with new right lower-extremity weakness, perineal pain, and left plantar foot numbness. Repeat spinal angiography demonstrated 2 de novo intertwined conus medullaris spAVFs.

scholarly journals Clinical and angioarchitectural characteristics of spinal vascular malformations of the cervical spine

2020 ◽  
Vol 32 (5) ◽  
pp. 755-762 ◽  
Author(s):  
Waleed Brinjikji ◽  
Elisa Colombo ◽  
Giuseppe Lanzino
Keyword(s):  
Cervical Spine ◽  
Lower Extremity ◽  
Clinical Presentation ◽  
Vascular Malformations ◽  
Case Series ◽  
Acute Onset ◽  
Lower Extremity Weakness ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Interventional Neuroradiologist

OBJECTIVEVascular malformations of the cervical spine are exceedingly rare. To date there have been no large case series describing the clinical presentation and angioarchitectural characteristics of cervical spine vascular malformations. The authors report their institutional case series on cervical spine vascular malformations diagnosed and treated at their institution.METHODSThe authors retrospectively reviewed all patients with spinal vascular malformations from their institution from January 2001 to December 2018. Patients with vascular malformations of the cervical spine were included. Lesions were characterized by their angioarchitectural characteristics by an interventional neuroradiologist and endovascular neurosurgeon. Data were collected on clinical presentation, imaging findings, treatment outcomes, and long-term follow-up. Descriptive statistics are reported.RESULTSOf a total of 213 patients with spinal vascular malformations, 27 (12.7%) had vascular malformations in the cervical spine. The mean patient age was 46.1 ± 21.9 years and 16 (59.3%) were male. The most common presentations were lower-extremity weakness (13 patients, 48.1%), tetraparesis (8 patients, 29.6%), and lower-extremity sensory dysfunction (7 patients, 25.9%). Nine patients (33.3%) presented with hemorrhage. Fifteen patients (55.6%) had modified Rankin Scale scores of 0–2 at the time of diagnosis. Regarding angioarchitectural characteristics, 8 patients (29.6%) had intramedullary arteriovenous malformations (AVMs), 5 (18.5%) had epidural arteriovenous fistulas (AVFs), 4 (14.8%) had paraspinal fistulas, 4 (14.8%) had mixed epidural/intradural fistulas, 3 (11.1%) had perimedullary AVMs, 2 (7.4%) had dural fistulas, and 1 patient (3.7%) had a perimedullary AVF.CONCLUSIONSThis retrospective study of 27 patients with cervical spine vascular malformations is the largest series to date on these lesions. The authors found substantial angioarchitectural heterogeneity with the most common types being intramedullary AVMs followed by epidural AVFs, paraspinal fistulas, and mixed intradural/extradural fistulas. Angioarchitecture dictated the clinical presentation as intradural shunts were more likely to present with hemorrhage and acute onset myelopathy, while dural and extradural shunts presented as either incidental lesions or gradually progressive congestive myelopathy.

scholarly journals Multiple Dural Arteriovenous Fistulas

2002 ◽  
Vol 8 (2) ◽  
pp. 183-191 ◽  
Author(s):  
A.J.P. Goddard ◽  
M.S. Khangure
Keyword(s):  
De Novo ◽  
Disease Process ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
External Carotid ◽  
Unique Case ◽  
Arteriovenous Fistulas ◽  
Type Iv ◽  
Dural Arteriovenous Fistulas

Dural arteriovenous fistulas are most probably acquired lesions. However, they have been rarely encountered de novo. We present a unique case of a 71-year-old woman who initially presented with right-sided dural arteriovenous fistula (DAVF), which spontaneously resolved after diagnostic arteriography. She later developed asymptomatic occlusion of the left transverse sinus. Five years after her initial presentation she developed left-sided pulse-synchronous tinnitus. MRA and catheter angiography showed a complex type IV DAVF between the left transverse sinus and multiple dural branches arising from both left and right external carotid arteries. The left transverse sinus was isolated from the torcula herophili, with stenosis of the sigmoid sinus. Extensive cortical venous drainage was demonstrated. Endovascular cure was effected by polyvinyl alcohol particle and absolute alcohol occlusion of the dominant dural supply, and transvenous coil occlusion of the left transverse sinus. The patient's symptoms resolved almost immediately. This unique case demonstrates that dural sinus occlusion and DAVFs may co-exist, but there may not be a causal relationship. It is likely that both DAVFs and sinus occlusion are manifestations of the same disease process characterised by a pro-thrombotic state and secondary angiogenesis. It is important to recognise that changes in symptomatology, even long after apparent disappearance of a lesion may indicate recurrence, and careful follow up is advocated.

Late diagnosis of spinal dural arteriovenous fistulas resulting in severe lower-extremity weakness: a case series

2015 ◽  
Vol 15 (6) ◽  
pp. e39-e44 ◽  
Author(s):  
Ivelin Iovtchev ◽  
Nurith Hiller ◽  
Yona Ofran ◽  
Isabella Schwartz ◽  
Jose Cohen ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Case Series ◽  
Late Diagnosis ◽  
Lower Extremity Weakness ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

scholarly journals Computed Tomography Angiography for Detection of Middle Meningeal Artery Lesions Associated with Acute Epidural Hematomas

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Wellingson Silva Paiva ◽  
Almir Ferreira Andrade ◽  
Robson Luis Oliveira De Amorim ◽  
Edson Bor-Seng-Shu ◽  
Gabriel Gattas ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Traffic Accidents ◽  
Epidural Hematoma ◽  
Middle Meningeal Artery ◽  
Vascular Lesion ◽  
Conventional Angiography ◽  
Cerebral Angiogram ◽  
History Of ◽  
Acute Epidural Hematoma ◽  
Meningeal Artery

Background.The natural history of traumatic aneurysms of the middle meningeal artery (MMA) is not well known, but patients with these lesions are more likely to have delayed bleeds. In this paper, we described a series of patients with epidural hematoma who underwent angiotomography (CTA) for MMA vascular lesion diagnosis.Methods.Eleven patients admitted to our emergency unit with small acute epidural hematoma were prospectively studied. All patients with temporal acute epidural hematomas underwent CTA and cerebral angiogram at our institution for diagnosis of posttraumatic lesions of middle meningeal artery. The findings of angiotomography and digital angiography were reviewed by radiologist and angiographers, respectively, to ensure that the lesions were readily diagnosed without knowing the results of angiotomography and to compare CTA findings with standard angiogram.Results.The causes of head injury were traffic accidents, falls, and aggression. Three of these patients presented traumatic MMA pseudoaneurysm. CT angiography was able to diagnose all of them, with dimensions ranging from 1.5 to 2.8 mm. Conventional angiography confirmed the findings of CT angiography, and the lesions presented with similar dimensions at both methods.Conclusions.We believe that angiotomography can be a useful technique for diagnosis of vascular lesion associated with small epidural hematoma.

Right Lower Extremity Weakness Following a Traumatic High Conus Medullaris Injury: A Case Report

PM&R ◽  
2013 ◽  
Vol 5 ◽  
pp. S260-S260
Author(s):  
Harnoor S. Tokhie ◽  
Neha Shah ◽  
Raymond Lee ◽  
Edward Park
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Conus Medullaris ◽  
Lower Extremity Weakness

scholarly journals Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas

2017 ◽  
Vol 26 (5) ◽  
pp. 613-620 ◽  
Author(s):  
Deena M. Nasr ◽  
Waleed Brinjikji ◽  
Michelle J. Clarke ◽  
Giuseppe Lanzino
Keyword(s):  
Lower Extremity ◽  
Functional Status ◽  
Treatment Outcomes ◽  
Clinical Presentation ◽  
Type I ◽  
Duration Of Symptoms ◽  
Lower Extremity Weakness ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Spinal Epidural

OBJECTIVESpinal epidural arteriovenous fistulas (SEDAVFs) constitute a rare but treatable cause of vascular myelopathy and are a different subtype from the more common Type I spinal dural AVFs. The purpose of this study was to review a consecutive series of SEDAVFs from a single institution and report on the clinical presentations, functional status, and treatment outcomes.METHODSThe authors identified all SEDAVFs treated at their institution from 2005 to 2015. SEDAVFs were defined as spinal AVFs in which the fistulous connection occurred in the epidural venous plexus. The clinical presentation, functional status, immediate treatment outcomes, and long-term neurological outcomes were analyzed.RESULTSTwenty-four patients with SEDAVFs were included in this study. The patients' mean age at presentation was 66.9 years. The most common presenting symptoms were pain and numbness (22 patients, 91.7%), followed by lower-extremity weakness (21 patients, 87.5%). The mean duration of symptoms prior to diagnosis was 11.8 months. Eighteen patients (75.0%) were treated with endovascular therapy alone, 4 (16.7) with surgery, and 2 (8.3%) with a combination of techniques. There was 1 major treatment-related complication (4.2%). Fifteen patients (62.5%) had improvement in disability, and 12 patients (54.5%) had improvement in sensory symptoms.CONCLUSIONSSEDAVFs often present with lower-extremity motor dysfunction and sensory symptoms. With the availability of newer liquid embolic agents, these lesions can be effectively treated with endovascular techniques. Surgery is also effective at treating these lesions, especially in situations where endovascular embolization fails or is not safe and in patients presenting with mass effect from compressive varices.

Concurrent spinal dural and intradural arteriovenous fistulas

2001 ◽  
Vol 95 (1) ◽  
pp. 96-99 ◽  
Author(s):  
Phong Dam-Hieu ◽  
Jean-François Mineo ◽  
Alionka Bostan ◽  
Michel Nonent ◽  
Gérard Besson
Keyword(s):  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Type Iv ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Arteriovenous Malformations ◽  
Spinal Avm

✓ Among spinal arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs) should be distinguished from intradural AVMs. The authors report the unusual and well-documented case of a 49-year-old man who suffered from a rapidly progressive myelopathy. Two concurrent spinal AVMs (one DAVF and one intradural direct AVF [Anson—Spetzler Type IV-B AVM]) were found located in the midthoracic region and in the conus medullaris, respectively. Both AVMs were successfully treated by surgery. To the authors' knowledge, the association of these two pathological entities has not been previously described. Clinically, if the patient fails to improve or deteriorates after the treatment of a spinal AVM, the presence of another AVM should be investigated by repeated angiography, especially if a complete spinal angiography study was not initially performed.

Cauda Equina Syndrome

2000 ◽  
Vol 5 (1) ◽  
pp. 1-2
Author(s):  
Leon H. Ensalada
Keyword(s):  
Lower Extremity ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Leg Pain ◽  
Lower Extremity Function ◽  
Lower Extremity Weakness ◽  
Injury Model ◽  
History Of ◽  
Radicular Syndrome ◽  
Lumbar Spinal

Abstract The cauda equina is a collection of peripheral nerves in the common dural sheath within the lumbar spinal canal. Cauda equina syndrome, also known as bilateral acute radicular syndrome, usually is caused by a large, sequestered acute disc rupture at L3-4, L4-5, or L5-S1 that produces partial or complete lesions of the cauda equina–lower motor neuron lesions associated with flaccid paralysis, atrophy, and other conditions. Patients usually present with a history of back symptoms that have worsened precipitously. The syndrome includes back pain, bilateral leg pain, saddle anesthesia, bilateral lower extremity weakness, urinary bladder retention, and lax rectal tone. Cauda equina syndrome is rated using Diagnosis-related estimates (DRE) lumbosacral categories VI or VII. Category VI, Cauda Equina–like Syndrome Without Bowel or Bladder Signs, is used when there is permanent bilateral partial loss of lower extremity function but no bowel or bladder impairment. Category VII, Cauda Equina Syndrome with Bowel or Bladder Impairment, is similar to Category VI but also includes bowel or bladder impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) uses the term cauda equina syndrome with reference to both the thoracolumbar and cervicothoracic spine regions; this usage is unique to the AMA Guides but maintains the internal consistency of the Injury Model, which is the best approach to date for assessing spine impairment.

Hydromyelia Complicating Apert's Syndrome: A Case Report

Neurosurgery ◽  
1985 ◽  
Vol 17 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Dennis G. Vollmer ◽  
T.S. Park ◽  
Wayne S. Cail ◽  
John A. Jane
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Lower Extremity ◽  
Foramen Magnum ◽  
Conus Medullaris ◽  
Posterior Fossa Decompression ◽  
Lower Extremity Weakness ◽  
Craniofacial Anomaly ◽  
Apert's Syndrome

Abstract A 7-year-old boy with Apert's syndrome and hydrocephalus presented with scoliosis and lower extremity weakness. Neuroradiological evaluation demonstrated bony abnormalities involving the foramen magnum and a markedly hydromyelic spinal cord. Clinical improvement followed posterior fossa decompression and a myelotomy on the caudal conus medullaris. A possible role of the craniofacial anomaly in the pathogenesis of the hydromyelia is discussed.

scholarly journals A Case of Guillain-Barré Syndrome as the First Presentation of Systemic Lupus Erythematosus

2021 ◽  
Vol 18 (4) ◽  
Author(s):  
Zeinab Saremi ◽  
Mahdi Bakhshi Mohammadi ◽  
Zahra Ahmadi
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lower Extremity ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Guillain Barre Syndrome ◽  
Systemic Lupus ◽  
Lower Extremity Weakness ◽  
Guillain Barré Syndrome ◽  
History Of ◽  
Guillain Barré

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with different clinical manifestations. Acute [resembling Guillain-Barré syndrome (GBS)] or chronic (chronic inflammatory demyelinating polyradiculoneuropathy) inflammatory polyradiculoneuropathy has been reported in rare SLE cases. Case Presentation: We reported a 39-year-old woman that presented with acute peripheral neuropathy, and she was eventually diagnosed with SLE. She developed distal numbness and paraesthesia followed by progressive upper and lower extremity weakness and difficulty in swallowing and speaking. She had a history of flu-like illness three weeks before to symptoms. Conclusions: Progressive upper and lower extremity weakness along with areflexia and electrodiagnostic findings suggested the diagnosis of Guillain-Barré syndrome. Over a month, significant neurological recovery occurred, and the patient's function continued to recover.

Sign in / Sign up

Export Citation Format

Share Document