Spinal dural arteriovenous shunt presenting with intramedullary hemorrhage
Journal of Neurosurgery: Journal of Neurosurgery: Spine: Table of Contents
Journal of Neurosurgery: Spine, Volume 20, Issue 3, Page 322-326, March 2014.
The authors report on a 49-year-old man with a thoracic spinal dural arteriovenous shunt (dAVS) in which rupture of a varix caused intramedullary hemorrhage. In the literature, patients with a thoracic dAVS predominantly present with congestive myelopathy; however, the patient featured in this report presented without increased deep tendon reflexes or muscle weakness, but instead with intermittent stabbing chest pain and paresthesia. Magnetic resonance images and angiograms demonstrated tortuous enlargement and the formation of a varix-like structure of the draining veins, features compatible with those of high-flow angiopathy. Recognition of this phenomenon is important in thoracic dAVS because intramedullary hemorrhage dramatically degrades outcome. A high index of clinical suspicion can prevent a similar case of thoracic dAVS from progressing to intramedullary hemorrhage.
Original Article: http://thejns.org/doi/abs/10.3171/2013.12.SPINE12163?ai=rt&mi=0&af=R
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