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Intraventricular hemorrhage as a false localizing sign of a thoracolumbar arteriovenous malformation: case report.
Surg Neurol. 1999 Apr; 51(4):430-4.SN

Abstract

BACKGROUND

Spinal arteriovenous malformation (SAVM) is a relatively rare disease characterized by a high incidence of intramedullary and subarachnoid haemorrhage. When the hemorrhage is profuse and the SAVM is in the cervical region the symptoms (disturbance of consciousness, papilledema, cranial nerve palsies, and convulsions) may be so severe and rapid in their onset that they may be mistaken for intracranial hemorrhage. We report here on a patient with a SAVM at T10-12, which bled intracranially, mainly intraventricularly, and resulted first in respiratory arrest and unconsciousness.

CASE DESCRIPTION

The patient had been well until he was 28 years old when, during intercourse, he suffered a terrible headache and suddenly lost consciousness, with a transient respiratory arrest. He was also noted to have right hemiparesis. A computed tomography scan demonstrated intraventricular hemorrhage. After a 24-hour period of artificial ventilation the patient regained consciousness and the right arm paresis completely recovered, but a gradual worsening of the motor function of the left leg developed. Digital subtraction angiography did not demonstrate any intracranial source of bleeding, whereas spinal angiography revealed a SAVM located at the medullary cone, which was totally removed by surgery.

CONCLUSION

The case reported here raises several important issues. First, the advisability of spinal magnetic resonance imaging in the investigation of intraventricular (and subarachnoid) hemorrhage in patients with no demonstrable intracranial source. Secondly, the benefits of early diagnosis and reestablishment of the spinal cord circulation before the onset of thrombosis and the progressive phase of myelopathy. Finally, the necessity of complete obliteration and treatment of SAVMs even in patients with fixed neurologic deficits, because rebleeding of lower thoracic or lumbar SAVMs can lead to impairment at a higher level with severe or lethal consequences.

Authors+Show Affiliations

Department of Neurosurgery, Albert Szent-Györgyi Medical University, Szeged, Hungary.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

10199298

Citation

Barzó, P, et al. "Intraventricular Hemorrhage as a False Localizing Sign of a Thoracolumbar Arteriovenous Malformation: Case Report." Surgical Neurology, vol. 51, no. 4, 1999, pp. 430-4.
Barzó P, Vörös E, Bodosi M. Intraventricular hemorrhage as a false localizing sign of a thoracolumbar arteriovenous malformation: case report. Surg Neurol. 1999;51(4):430-4.
Barzó, P., Vörös, E., & Bodosi, M. (1999). Intraventricular hemorrhage as a false localizing sign of a thoracolumbar arteriovenous malformation: case report. Surgical Neurology, 51(4), 430-4.
Barzó P, Vörös E, Bodosi M. Intraventricular Hemorrhage as a False Localizing Sign of a Thoracolumbar Arteriovenous Malformation: Case Report. Surg Neurol. 1999;51(4):430-4. PubMed PMID: 10199298.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraventricular hemorrhage as a false localizing sign of a thoracolumbar arteriovenous malformation: case report. AU - Barzó,P, AU - Vörös,E, AU - Bodosi,M, PY - 1999/4/13/pubmed PY - 1999/4/13/medline PY - 1999/4/13/entrez SP - 430 EP - 4 JF - Surgical neurology JO - Surg Neurol VL - 51 IS - 4 N2 - BACKGROUND: Spinal arteriovenous malformation (SAVM) is a relatively rare disease characterized by a high incidence of intramedullary and subarachnoid haemorrhage. When the hemorrhage is profuse and the SAVM is in the cervical region the symptoms (disturbance of consciousness, papilledema, cranial nerve palsies, and convulsions) may be so severe and rapid in their onset that they may be mistaken for intracranial hemorrhage. We report here on a patient with a SAVM at T10-12, which bled intracranially, mainly intraventricularly, and resulted first in respiratory arrest and unconsciousness. CASE DESCRIPTION: The patient had been well until he was 28 years old when, during intercourse, he suffered a terrible headache and suddenly lost consciousness, with a transient respiratory arrest. He was also noted to have right hemiparesis. A computed tomography scan demonstrated intraventricular hemorrhage. After a 24-hour period of artificial ventilation the patient regained consciousness and the right arm paresis completely recovered, but a gradual worsening of the motor function of the left leg developed. Digital subtraction angiography did not demonstrate any intracranial source of bleeding, whereas spinal angiography revealed a SAVM located at the medullary cone, which was totally removed by surgery. CONCLUSION: The case reported here raises several important issues. First, the advisability of spinal magnetic resonance imaging in the investigation of intraventricular (and subarachnoid) hemorrhage in patients with no demonstrable intracranial source. Secondly, the benefits of early diagnosis and reestablishment of the spinal cord circulation before the onset of thrombosis and the progressive phase of myelopathy. Finally, the necessity of complete obliteration and treatment of SAVMs even in patients with fixed neurologic deficits, because rebleeding of lower thoracic or lumbar SAVMs can lead to impairment at a higher level with severe or lethal consequences. SN - 0090-3019 UR - https://www.unboundmedicine.com/medline/citation/10199298/Intraventricular_hemorrhage_as_a_false_localizing_sign_of_a_thoracolumbar_arteriovenous_malformation:_case_report_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-3019(98)00044-5 DB - PRIME DP - Unbound Medicine ER -