[Ruptured Spinal Arteriovenous Malformation Mimicking Bacterial Meningitis:A Case Report]

A 23-year-old woman was referred to our hospital with progressive headache and back pain. Cerebrospinal fluid(CSF)analysis revealed hypoglycorrhachia and pleocytosis. However, imaging studies did not reveal evidence of subarachnoid hemorrhage(SAH), and she was diagnosed with bacterial meningitis. CSF analysis repeated after antibiotic treatment continued to show evidence of blood. Spinal SAH was suspected, and MRI revealed a spinal arteriovenous malformation(AVM). Spinal digital subtraction angiography revealed the nidus and a feeder aneurysm, which was implicated as the source of bleeding;therefore, she was diagnosed with spinal SAH secondary to spinal intramedullary AVM(SAVM). She underwent endovascular treatment for the spinal aneurysm and was discharged without worsening neurological symptoms. SAVMs presenting without neurological findings and/or evidence of bleeding on plain CT images are diagnostically challenging;notably, findings on CSF analysis could mimic those observed in cases of infectious disease. We should cite vascular diseases such as SAVM.