Republished: A lumbar arteriovenous fistula presenting with intraventricular hemorrhage and hydrocephalus

Area of Science:

• Neurology
• Pediatric Neurosurgery
• Vascular Neurology

Background:

• Pediatric spinal vascular malformations are uncommon and typically manifest with localized symptoms.
• Arteriovenous fistulas (AVFs) in the spine are rare causes of neurological deficits in children.

Observation:

• A previously healthy child presented with lethargy and headache, showing ventriculomegaly and trace intraventricular blood on initial imaging.
• Symptoms partially resolved with cerebrospinal fluid (CSF) diversion via an external ventricular drain.

Findings:

• A lumbar spinal dural/perimedullary arteriovenous fistula (AVF) was diagnosed as the underlying cause.
• The AVF was successfully treated with endovascular embolization.
• The patient experienced post-embolization vasospasm requiring further endovascular intervention and eventual ventriculoperitoneal shunt placement.

Implications:

• This case underscores the importance of considering the entire neuroaxis in the diagnostic workup for pediatric hydrocephalus.
• Spinal AVFs can present atypically, necessitating a broad differential diagnosis in pediatric neurological emergencies.
• Comprehensive neuroimaging and timely intervention are crucial for favorable outcomes in pediatric spinal vascular malformations.