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Spinal Glomus Arteriovenous Malformation Manifesting with a Subarachnoid Hemorrhage.
World Neurosurg. 2017 Feb; 98:874.e1-874.e6.WN

Abstract

BACKGROUND

Spinal arteriovenous malformations (AVMs) are rare lesions that may cause serious neurologic morbidity. With developments in endovascular technology and embolic materials, endovascular management of spinal AVMs has gained popularity.

CASE DESCRIPTION

A 61-year-old woman presented with the worst headache of her life and an acute onset of nausea and vomiting and was shown to have a grade 2 subarachnoid hemorrhage (SAH) on computed tomography scan. A 6-vessel cerebral angiogram was negative for any vascular abnormalities. Magnetic resonance imaging and magnetic resonance angiography of the neck showed a flow-related enhancement compatible with a vascular abnormality at the level of C2. Cervical spinal angiography showed a cervical spinal cord glomus (type II) AVM at the level of C2 draining into perimedullary venous plexus. Transarterial Onyx embolization was performed and resulted in complete occlusion of the AVM. The patient made a complete neurologic recovery.

CONCLUSIONS

Spinal AVMs manifesting as intracranial SAH are uncommon. These lesions are frequently overlooked on cerebral angiography and account for a small proportion of angiogram-negative SAHs. A negative angiogram in the setting of SAH should prompt a comprehensive evaluation of the cervical segmental arterial supply to exclude a cervical spinal AVM. Endovascular embolization may be effective in treating spinal glomus AVMs with good clinical outcomes and with complete angiographic obliteration. Onyx embolic agent should be considered as the agent of choice to manage spinal glomus AVMs.

Authors+Show Affiliations

Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA. Electronic address: pascal.jabbour@jefferson.edu.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27923749

Citation

Daou, Badih, et al. "Spinal Glomus Arteriovenous Malformation Manifesting With a Subarachnoid Hemorrhage." World Neurosurgery, vol. 98, 2017, pp. 874.e1-874.e6.
Daou B, Atallah E, Al-Saiegh F, et al. Spinal Glomus Arteriovenous Malformation Manifesting with a Subarachnoid Hemorrhage. World Neurosurg. 2017;98:874.e1-874.e6.
Daou, B., Atallah, E., Al-Saiegh, F., Alkhalili, K., Tjoumakaris, S., Rosenwasser, R. H., & Jabbour, P. (2017). Spinal Glomus Arteriovenous Malformation Manifesting with a Subarachnoid Hemorrhage. World Neurosurgery, 98, e1-e6. https://doi.org/10.1016/j.wneu.2016.11.123
Daou B, et al. Spinal Glomus Arteriovenous Malformation Manifesting With a Subarachnoid Hemorrhage. World Neurosurg. 2017;98:874.e1-874.e6. PubMed PMID: 27923749.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spinal Glomus Arteriovenous Malformation Manifesting with a Subarachnoid Hemorrhage. AU - Daou,Badih, AU - Atallah,Elias, AU - Al-Saiegh,Fadi, AU - Alkhalili,Kenan, AU - Tjoumakaris,Stavropoula, AU - Rosenwasser,Robert H, AU - Jabbour,Pascal, Y1 - 2016/12/03/ PY - 2016/09/12/received PY - 2016/11/22/revised PY - 2016/11/23/accepted PY - 2016/12/8/pubmed PY - 2017/9/16/medline PY - 2016/12/8/entrez KW - Angiogram-negative subarachnoid hemorrhage KW - Arteriovenous malformation KW - Glomus KW - Onyx KW - SAH KW - Spine KW - Subarachnoid hemorrhage SP - 874.e1 EP - 874.e6 JF - World neurosurgery JO - World Neurosurg VL - 98 N2 - BACKGROUND: Spinal arteriovenous malformations (AVMs) are rare lesions that may cause serious neurologic morbidity. With developments in endovascular technology and embolic materials, endovascular management of spinal AVMs has gained popularity. CASE DESCRIPTION: A 61-year-old woman presented with the worst headache of her life and an acute onset of nausea and vomiting and was shown to have a grade 2 subarachnoid hemorrhage (SAH) on computed tomography scan. A 6-vessel cerebral angiogram was negative for any vascular abnormalities. Magnetic resonance imaging and magnetic resonance angiography of the neck showed a flow-related enhancement compatible with a vascular abnormality at the level of C2. Cervical spinal angiography showed a cervical spinal cord glomus (type II) AVM at the level of C2 draining into perimedullary venous plexus. Transarterial Onyx embolization was performed and resulted in complete occlusion of the AVM. The patient made a complete neurologic recovery. CONCLUSIONS: Spinal AVMs manifesting as intracranial SAH are uncommon. These lesions are frequently overlooked on cerebral angiography and account for a small proportion of angiogram-negative SAHs. A negative angiogram in the setting of SAH should prompt a comprehensive evaluation of the cervical segmental arterial supply to exclude a cervical spinal AVM. Endovascular embolization may be effective in treating spinal glomus AVMs with good clinical outcomes and with complete angiographic obliteration. Onyx embolic agent should be considered as the agent of choice to manage spinal glomus AVMs. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/27923749/Spinal_Glomus_Arteriovenous_Malformation_Manifesting_with_a_Subarachnoid_Hemorrhage_ DB - PRIME DP - Unbound Medicine ER -