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Cervical spinal epidural arteriovenous fistula with coexisting spinal anterior spinal artery aneurysm presenting as subarachnoid hemorrhage--case report.
J Stroke Cerebrovasc Dis. 2014 Nov-Dec; 23(10):e461-e465.JS

Abstract

Hemorrhagic presentation of spinal epidural arteriovenous fistulas (AVFs) is rare in patients with cervical spinal vascular lesions. The present report describes a patient with cervical spine epidural AVFs associated with anterior spinal artery aneurysm at the same vertebral level presenting with subarachnoid hemorrhage. A 54-year-old man presented with sudden onset of headache. Computed tomography of the head showed subarachnoid hemorrhage. Diagnostic angiography revealed an epidural AVF located at the C1-2 level that was fed mainly by the dorsal somatic branches of the segmental arteries from the radicular artery and anterior spinal artery. This AVF drained only into the epidural veins without perimedullary venous reflux. Further, there was a 4-mm anterior spinal artery aneurysm in the vicinity of the fistula that was thought to be the cause of the hemorrhage. Endovascular transarterial fistulas embolization from the right radicular artery was performed to eliminate the AVF and to reduce hemodynamic stress on the aneurysm. No new symptoms developed after the treatment and discharged without neurological deficits. The aneurysm was noted to be reduced in size after the treatment and totally disappeared by 1 year later, according to follow-up angiography. Anterior spinal artery aneurysm from a separate vascular distribution may coexist with spinal epidural AVFs. In the setting of spinal subarachnoid hemorrhage, comprehensive imaging is indicated to rule out such lesions.

Authors+Show Affiliations

Department of Neurosurgery, Nara Medical University, Kashihara City, Japan. Electronic address: nakagawa@naramed-u.ac.jp.Department of Neurosurgery, Nara Medical University, Kashihara City, Japan.Department of Neurosurgery, Nara Medical University, Kashihara City, Japan.Department of Radiology, Nara Medical University, Kashihara City, Japan.Department of Radiology, Nara Medical University, Kashihara City, Japan.Department of Neurosurgery, Nara Medical University, Kashihara City, Japan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25284720

Citation

Nakagawa, Ichiro, et al. "Cervical Spinal Epidural Arteriovenous Fistula With Coexisting Spinal Anterior Spinal Artery Aneurysm Presenting as Subarachnoid Hemorrhage--case Report." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 23, no. 10, 2014, pp. e461-e465.
Nakagawa I, Park HS, Hironaka Y, et al. Cervical spinal epidural arteriovenous fistula with coexisting spinal anterior spinal artery aneurysm presenting as subarachnoid hemorrhage--case report. J Stroke Cerebrovasc Dis. 2014;23(10):e461-e465.
Nakagawa, I., Park, H. S., Hironaka, Y., Wada, T., Kichikawa, K., & Nakase, H. (2014). Cervical spinal epidural arteriovenous fistula with coexisting spinal anterior spinal artery aneurysm presenting as subarachnoid hemorrhage--case report. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 23(10), e461-e465. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.07.012
Nakagawa I, et al. Cervical Spinal Epidural Arteriovenous Fistula With Coexisting Spinal Anterior Spinal Artery Aneurysm Presenting as Subarachnoid Hemorrhage--case Report. J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):e461-e465. PubMed PMID: 25284720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical spinal epidural arteriovenous fistula with coexisting spinal anterior spinal artery aneurysm presenting as subarachnoid hemorrhage--case report. AU - Nakagawa,Ichiro, AU - Park,Hun-Soo, AU - Hironaka,Yasuo, AU - Wada,Takeshi, AU - Kichikawa,Kimihiko, AU - Nakase,Hiroyuki, Y1 - 2014/10/03/ PY - 2014/06/16/received PY - 2014/07/06/revised PY - 2014/07/09/accepted PY - 2014/10/7/entrez PY - 2014/10/7/pubmed PY - 2015/11/11/medline KW - Aneurysm KW - anterior spinal artery KW - epidural arteriovenous fistula KW - subarachnoid hemorrhage KW - transarterial embolization SP - e461 EP - e465 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 23 IS - 10 N2 - Hemorrhagic presentation of spinal epidural arteriovenous fistulas (AVFs) is rare in patients with cervical spinal vascular lesions. The present report describes a patient with cervical spine epidural AVFs associated with anterior spinal artery aneurysm at the same vertebral level presenting with subarachnoid hemorrhage. A 54-year-old man presented with sudden onset of headache. Computed tomography of the head showed subarachnoid hemorrhage. Diagnostic angiography revealed an epidural AVF located at the C1-2 level that was fed mainly by the dorsal somatic branches of the segmental arteries from the radicular artery and anterior spinal artery. This AVF drained only into the epidural veins without perimedullary venous reflux. Further, there was a 4-mm anterior spinal artery aneurysm in the vicinity of the fistula that was thought to be the cause of the hemorrhage. Endovascular transarterial fistulas embolization from the right radicular artery was performed to eliminate the AVF and to reduce hemodynamic stress on the aneurysm. No new symptoms developed after the treatment and discharged without neurological deficits. The aneurysm was noted to be reduced in size after the treatment and totally disappeared by 1 year later, according to follow-up angiography. Anterior spinal artery aneurysm from a separate vascular distribution may coexist with spinal epidural AVFs. In the setting of spinal subarachnoid hemorrhage, comprehensive imaging is indicated to rule out such lesions. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/25284720/Cervical_spinal_epidural_arteriovenous_fistula_with_coexisting_spinal_anterior_spinal_artery_aneurysm_presenting_as_subarachnoid_hemorrhage__case_report_ DB - PRIME DP - Unbound Medicine ER -