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Cervical spine dural arteriovenous fistula with coexisting spinal radiculopial artery aneurysm presenting as subarachnoid hemorrhage: case report.
Neurosurgery. 2012 Jan; 70(1):E259-63; discussion E263.N

Abstract

BACKGROUND AND IMPORTANCE

We present a patient with a cervical spine dural arteriovenous fistula associated with a radiculopial artery aneurysm at the same vertebral level presenting with subarachnoid hemorrhage.

CLINICAL PRESENTATION

A 45-year-old Native American man presented with sudden-onset severe headache, lethargy, and right hemiparesis. Computed tomography (CT) of the head showed subarachnoid hemorrhage and hydrocephalus. A subsequent CT of the neck showed an anterior spinal subdural hematoma from C2 to C4 causing mild cord compression. Carotid and vertebral angiography failed to demonstrate an intracranial aneurysm, but showed a spinal dural arteriovenous fistula originating from the right vertebral artery at the C5 neuroforamen. The severity of the patient's symptoms, atypical for rupture of a dural arteriovenous fistula, prompted more thorough angiographic evaluation. Thus, injection of the right thyrocervical trunk was performed, demonstrating a 4-mm spinal radiculopial artery aneurysm. Following ventriculostomy, a hemilaminectomy from C4 to C7 was performed with disconnection of the fistula from its drainage system. Subsequent resection of the aneurysm, which was determined to be the cause of the hemorrhage, was accomplished. The patient improved neurologically and was discharged to rehabilitation.

CONCLUSION

Spinal cord aneurysms from a separate vascular distribution may coexist with spinal dural arteriovenous fistulas. In the setting of spinal hemorrhage, especially in situations with an atypical clinical presentation, comprehensive imaging is indicated to rule out such lesions.

Authors+Show Affiliations

Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. joshualu@usc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

21795862

Citation

Lucas, Joshua W., et al. "Cervical Spine Dural Arteriovenous Fistula With Coexisting Spinal Radiculopial Artery Aneurysm Presenting as Subarachnoid Hemorrhage: Case Report." Neurosurgery, vol. 70, no. 1, 2012, pp. E259-63; discussion E263.
Lucas JW, Jones J, Farin A, et al. Cervical spine dural arteriovenous fistula with coexisting spinal radiculopial artery aneurysm presenting as subarachnoid hemorrhage: case report. Neurosurgery. 2012;70(1):E259-63; discussion E263.
Lucas, J. W., Jones, J., Farin, A., Kim, P., & Giannotta, S. L. (2012). Cervical spine dural arteriovenous fistula with coexisting spinal radiculopial artery aneurysm presenting as subarachnoid hemorrhage: case report. Neurosurgery, 70(1), E259-63; discussion E263. https://doi.org/10.1227/NEU.0b013e31822ac0fb
Lucas JW, et al. Cervical Spine Dural Arteriovenous Fistula With Coexisting Spinal Radiculopial Artery Aneurysm Presenting as Subarachnoid Hemorrhage: Case Report. Neurosurgery. 2012;70(1):E259-63; discussion E263. PubMed PMID: 21795862.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical spine dural arteriovenous fistula with coexisting spinal radiculopial artery aneurysm presenting as subarachnoid hemorrhage: case report. AU - Lucas,Joshua W, AU - Jones,Jesse, AU - Farin,Azadeh, AU - Kim,Paul, AU - Giannotta,Steven L, PY - 2011/7/29/entrez PY - 2011/7/29/pubmed PY - 2012/8/14/medline SP - E259-63; discussion E263 JF - Neurosurgery JO - Neurosurgery VL - 70 IS - 1 N2 - BACKGROUND AND IMPORTANCE: We present a patient with a cervical spine dural arteriovenous fistula associated with a radiculopial artery aneurysm at the same vertebral level presenting with subarachnoid hemorrhage. CLINICAL PRESENTATION: A 45-year-old Native American man presented with sudden-onset severe headache, lethargy, and right hemiparesis. Computed tomography (CT) of the head showed subarachnoid hemorrhage and hydrocephalus. A subsequent CT of the neck showed an anterior spinal subdural hematoma from C2 to C4 causing mild cord compression. Carotid and vertebral angiography failed to demonstrate an intracranial aneurysm, but showed a spinal dural arteriovenous fistula originating from the right vertebral artery at the C5 neuroforamen. The severity of the patient's symptoms, atypical for rupture of a dural arteriovenous fistula, prompted more thorough angiographic evaluation. Thus, injection of the right thyrocervical trunk was performed, demonstrating a 4-mm spinal radiculopial artery aneurysm. Following ventriculostomy, a hemilaminectomy from C4 to C7 was performed with disconnection of the fistula from its drainage system. Subsequent resection of the aneurysm, which was determined to be the cause of the hemorrhage, was accomplished. The patient improved neurologically and was discharged to rehabilitation. CONCLUSION: Spinal cord aneurysms from a separate vascular distribution may coexist with spinal dural arteriovenous fistulas. In the setting of spinal hemorrhage, especially in situations with an atypical clinical presentation, comprehensive imaging is indicated to rule out such lesions. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/21795862/Cervical_spine_dural_arteriovenous_fistula_with_coexisting_spinal_radiculopial_artery_aneurysm_presenting_as_subarachnoid_hemorrhage:_case_report_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/NEU.0b013e31822ac0fb DB - PRIME DP - Unbound Medicine ER -