SPASTIC PARAPARESIS IN YOUNG MEN WITH SPINAL MENINGIOMA AND SPINAL ARTERIOVENOUS MALFORMATION: A CASE REPORT

Background: Compared to trauma cases, the publication of non-traumatic events is much less, although the incidence is estimated to be as much as a traumatic event. This case report presents spinal cord tumors together with arteriovenous malformation (AVM) in young men, where there are no previous case reports that the authors can find.Case Report: A 22-year-old male patient with complaints of pain in the back (NPRS 8-9), followed by difficulty moving the lower limb accompanied by a burning sensation, problem in defecation, and urination. We found motor weakness in the lower extremities (1/1), positive pathological reflexes, and sensibility disorders on physical examination.Discussion: According to history taking, physical examination, and MR Imaging, the spastic paraparesis symptom in this patient is likely due to a spinal cord tumor, which is meningioma (according to histopathological examination). Where back pain rarely presents in the patient with spinal AVM. Laminectomy and tumor destruction were the gold standards of therapy, and the symptom was relieved.Conclusion: A complete examination is the main key in determining the appropriate therapy for the patient's disease. In this case, the manifestation of spastic paraparesis was likely to be caused by meningioma rather than spinal AVM. Laminectomy and extirpation of the spinal meningioma were done as the gold standard of therapy, and the symptom was relieved. In contrast, spinal AVM was not performed­ and is still under observation.

Perimedullary Spinal Arteriovenous Malformation in an Elderly Female: A Case Report

Perimedullary spinal AVM is a rare type of spinal arteriovenous malformations. We present a case of 70 yrs female who presented with motor weakness in her bilateral limbs. Initial MRI was misinterpreted as ependymal myxoma; however, histopathology revealed spinal AVM. MRA or DSA should be conducted if AVM is suspected.

Metameric spinal AVM: Long-term symptomatic relief achieved by embolization of the extradural component

Background Metameric spinal cord arteriovenous malformations (AVMs) are rare lesions characterized by an intradural and extradural component. They are difficult to treat surgically by the endovascular route. We report a case in which symptomatic relief was achieved by embolization of the extradural component only. Case presentation A 35-year-old woman presented with acute worsening of back pain, weakness in the left leg and urinary retention. Spinal angiography showed a metameric spinal cord AVM with partial common venous drainage of the extradural and intradural components. Conclusions Targeted embolization of the extradural component led to dramatic improvement of the patient’s symptoms, probably by achieving venous decongestion. She remains neurologically stable at two years’ follow-up.

Ruptured Spinal Arteriovenous Malformation: A Rare Cause of Paraplegia in Pregnancy

Background. Ruptured spinal arteriovenous malformation (AVM) is a rare cause of paraplegia in pregnancy, with only a few case reports describing complications from spinal AVMs during pregnancy in the literature. Case. A 32-year-old woman presented at 37 weeks gestation with back pain and rapidly progressive lower limb neurological symptoms. MRI showed a previously undiagnosed spinal AVM at T8. A healthy girl was delivered by caesarean under general anaesthesia to facilitate further investigation. After spinal angiography, it was concluded the most likely aetiology was acute rupture of an intra- and perimedullary AVM with associated haemorrhage at T8 secondary to venous compression from the enlarged uterus at L5 causing high pressure within the AVM and subsequent rupture. The neurosurgical and interventional radiology teams felt the lesion was not amenable to surgical or endovascular intervention. The patient remained paraplegic with no sign of neurological recovery six months after delivery. Conclusion. While new onset paraplegia during pregnancy secondary to ruptured spinal AVM is very rare, it is important to discuss these cases to inform future practice. In contrast to previous case reports, our patient did not spontaneously recover after delivery and was not amenable to surgical or endovascular treatment.

Partially trombosed glomus type spinal arteriovenous malformation – case presentation

Spinal AVM are very rare vascular lesions and most o the studies give reports on only a few cases. Given their localization between the spinal tracts and the gray matter core of the medulla and their multiple feeders from posterior and anterior spinal arteries they are amongst the most difficult surgical pathology in the nervous sistem. We present the case of a 60 years old male with a glomus type T10-L2 spinal AVM that presented with motor deficit in the lower limbs and urinary incontinence. The partially thrombosed lesion was completely resected without previous embolisation, and the patient was walking with assistance at discharge. This is a rare case that presented with progressive neurological deterioration consistent with an ischemic rather than a hemorrhagic event. Microsurgery is a better option than conservative treatment in these rare cases of spontaneous occlusion of intramedullary arteriovenous malformations.

Spinal Arterio- venous lesions: Variable Clinical and Angiographic Feature

Background: Spinal Arterio-Venous Shunts are rare but treatable diseases. AVF has a direct shunt between artery and vein. AVM has a nidus between artery and vein. Differentiation is necessary because, the clinical presentation, angiographic architecture, and treatment options are different. Rationale: Presenting clinical features are nonspecific and vary in age and sex. MR images raise the suspicion of diagnosis. For proper understanding of disease and planning of treatment DSA is necessary. Objectives: To evaluate the nature of clinical feature, angiographic findings, and initial outcome after embolization in patients of spinal arterio-venous shunt. Materials & Methods: It was prospective study. Patients were referred for spinal DSA. Risk of complication was properly discussed with the patient and attendant and informed written consent was taken. Results: Among 9 patients, 5 were female and 4 were male. Male female ratio was 1: 1.25. Three patients were diagnosed as type I, three as type II, and three as type IV. All 3 patients (100%) of dural fistula were male, all 3 patients (100%) of pial fistula were female. Average age at presentation was 36 yrs. And mean age of dural AVF was 60.33 yrs, pial AVF was 18.33 yrs and spinal AVM was 29.33 yrs. Spinal DAVF occurred in patients ranging from 57 to 64 years of age, with an average age of 60.33 years. The average length of time between onset of symptoms and diagnosis was 16.44 months (ranging from 3 to 36 month). All 9 patients (100%) of patients had motor weakness, sensory disturbance was found in 66.66% (six of nine patients) and urinary disturbance was found in 77.77% (seven of nine patients). Progressive clinical course was followed in 100% of patients (all of nine patients). MRI findings revealed flow void in 77.77% of patients (seven of nine patients). Increased T2 signal in the spinal cord was present in 88.88% of patients (eight of nine patients). After DSA total 77.7% (seven of nine patients) feeder was located in low thoracic and lumbar region. Conclusion: Spinal AVM & AVF remain undiagnosed for a long period. They should be treated early for prevention of progressive morbidity and disability. MRI features of cord edema, contrast enhancement, and peri-medullary vessels may lead to the diagnosis of these vascular lesions. Bangladesh Journal of Neuroscience 2014; Vol. 30 (2): 62-68