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Cobb syndrome: case report
Ignacio Pascual-Castroviejo1, Remedios Frutos, Juan Viaño
1Pediatric Neurology Service, University Hospital La Paz, Madrid, Spain. pascas@inves.es
Insights
A rare case of a 7-year-old boy showed associated cutaneous hemangioma and spinal arteriovenous malformations. Both spinal and paraspinal malformations were found to originate from the same intercostal arteries.
Area of Science:
- Vascular malformations
- Pediatric neurology
- Radiology
Background:
- Arteriovenous malformations (AVMs) are complex vascular anomalies.
- Spinal AVMs can present with varied clinical manifestations.
- Co-occurrence of cutaneous and spinal vascular malformations is uncommon.
Observation:
- A 7-year-old boy presented with a cutaneous hemangioma.
- Physical examination revealed subtle cutaneous changes on the back, requiring tactile stimulation for detection.
- Magnetic resonance arteriography (MRA) identified both intramedullary and paraspinal arteriovenous malformations.
Findings:
- Selective intercostal arteriography confirmed that the intraspinal and paraspinal AVMs shared common feeding intercostal arteries.
- This finding suggests a potential shared vascular supply pathway for these distinct malformations.
- The cutaneous hemangioma's association with the spinal AVMs was noted.
Implications:
- Highlights the importance of thorough vascular imaging in pediatric patients with suspected spinal abnormalities.
- Suggests a possible syndromic association or shared developmental origin for combined cutaneous and spinal AVMs.
- Informs diagnostic and therapeutic strategies for complex vascular malformations in children.
Abstract:
We present a 7-year-old boy in whom cutaneous hemangioma and intramedullary and paraspinal arteriovenous malformations were associated. Magnetic resonance arteriography revealed the presence of the two arterovenous malformations, and the selective intercostal arteriography demonstrated that the intraspinal and paraspinal arteriovenous malformations were supplied by the same intercostal arteries. Rubbing the back was required to detect the cutaneous changes, which were only suspected by casual inspection.