Spinal Epidural Arteriovenous Fistulas With Unusual Manifestation of Sudden Onset of Severe Neurological Deficits: Case Report

Spinal epidural arteriovenous fistulas with perimedullary venous drainage cause venous hypertension, and usually manifest as slowly progressive myelopathy. We treated two patients presenting with sudden onset of severe neurological deficits. Moreover, in Case 1, the venous drainage was exclusively e...

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Published inNeurologia medico-chirurgica Vol. 53; no. 12; pp. 896 - 901
Main Authors MIYAMOTO, Naoko, NAITO, Isao, TAKATAMA, Shin, IWAI, Tomoyuki, TOMIZAWA, Shinichiro, INOUE, Hiroshi K
Format Journal Article
LanguageEnglish
Published Japan The Japan Neurosurgical Society 2013
Subjects
Adrenal Cortex Hormones - therapeutic use
Arteriovenous Fistula - complications
Arteriovenous Fistula - diagnosis
Case Report
Central Nervous System Vascular Malformations - complications
Central Nervous System Vascular Malformations - diagnosis
congestive myelopathy
Diagnosis, Differential
endovascular therapy
Epidural Space
Fecal Incontinence - etiology
Hemiplegia - etiology
Humans
Infarction - diagnosis
Laminectomy
Male
Middle Aged
Neck Pain - etiology
Quadriplegia - etiology
Spinal Cord - blood supply
Spinal Cord Compression - etiology
spinal epidural arteriovenous fistula
unusual manifestation
Urinary Incontinence - etiology
Venous Thrombosis - etiology
Young Adult
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Summary:Spinal epidural arteriovenous fistulas with perimedullary venous drainage cause venous hypertension, and usually manifest as slowly progressive myelopathy. We treated two patients presenting with sudden onset of severe neurological deficits. Moreover, in Case 1, the venous drainage was exclusively epidural and no perimedullary venous drainage was present. Angiographic findings of this patient were characterized by a slow-flow fistula with marked retention of the epidural venous drainage. Rapidly progressing thrombosis of the epidural venous plexus may have caused the sudden onset of the symptoms. In Case 2, hematomyelia may also be possibly associated with the sudden onset of the symptoms. Early diagnosis and treatment are essential to achieve favorable outcome in such cases because venous congestion results in irreversible venous infarction within a short period.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
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ISSN:0470-8105
1349-8029
DOI:10.2176/nmc.cr2012-0269