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[Perimedullary arteriovenous fistula. Case report and literature review]
M O Demin1, A R Tekoev1, Yu V Kushel1
1Burdenko Neurosurgical Center, Moscow, Russia.
Abstract:
Arteriovenous fistula is a common vascular abnormality of spinal cord and meninges. This disease is more common in young men. Clinical manifestation includes progressive sensitive and motor disorders. However, acute symptoms including impaired consciousness, head or back pain are also possible. The authors describe a rare case. A 15-year-old boy experienced acute depression of consciousness accompanied by headache, vomiting, weakness in the upper limbs and sensitive disorders. The patient was hospitalized to the intensive care unit and examined for subarachnoid hemorrhage. MRI of the head and cervical spine and direct invasive angiography were performed. Perimedullary AVF of cervical spinal cord was diagnosed. Complete clinical regression was observed within a month. Microsurgical removal of AVF was performed in scheduled fashion. Postoperative follow-up period was over 6 months.
Insights
A rare case of perimedullary arteriovenous fistula (AVF) in a young male presented with acute neurological decline. Surgical removal led to complete recovery, highlighting AVF as a treatable cause of spinal cord dysfunction.
Area of Science:
- Neurology
- Vascular Surgery
- Neurosurgery
Background:
- Spinal arteriovenous fistulas (AVFs) are vascular malformations affecting the spinal cord and meninges.
- They commonly present with progressive neurological deficits, but acute presentations are also documented.
Observation:
- A 15-year-old male presented with sudden decreased consciousness, headache, vomiting, and limb weakness.
- Initial investigations included MRI and angiography, revealing a perimedullary AVF of the cervical spinal cord.
Findings:
- The patient experienced complete clinical remission within one month.
- Successful microsurgical excision of the AVF was performed, with a follow-up exceeding six months.
Implications:
- This case underscores the importance of considering spinal AVF in young patients with acute neurological deterioration.
- Early diagnosis and surgical intervention can lead to favorable outcomes and prevent long-term disability.
