Intramedullary haemorrhage due to AVM located within the medulla oblongata in a three year old child. Case report

Intramedullary arteriovenous malformations are rare in childhood. Yasargil reports only two cases in children under ten years of age out of a total of forty-one cases of AVM operated on between 1967 and 1983 in which microsurgical techniques were used. The early symptoms of these lesions are those due to intramedullary or subarachnoid haemorrhage with neurological deficit, pain and/or weakness or numbness of one or more limbs. We report the case of an intramedullary haematoma due to arteriovenous malformation within the medulla oblongata in a three year old child admitted for cervical pain and right arm hypostenia. The CT scan and MRI showed an intramedullary expansive lesion with associated internal haematoma between C1-C7 level. Because of the rapid clinical deterioration upon the onset of right hemiparesis we procedeed to empty the intramedullary haematoma and to remove the intrabulbar AVM. A swift improvement of neurological deficit was observed along with a total regression of the symptomatology in a month's time. The excellent results reported in this case, very likely the only case in the literature occurring in a very small child at this spinal cord level, are mostly due to the early surgical treatment and to the exact information that MRI provided.