Spinal dural arteriovenous fistula with hematomyelia caused by intraparenchymal varix of draining vein.

BACKGROUND CONTEXT

Hemorrhage that results from spinal dural arteriovenous fistula (Type I arteriovenous malformation [AVM]) is uncommon. There are some reports of subarachnoid hemorrhage and subdural hematoma caused by Type I spinal AVM, but there are few reported cases of hematomyelia caused by spinal dural arteriovenous fistula.

PURPOSE

To describe an interesting patient who had hematomyelia caused by a dural arteriovenous fistula (Type I spinal AVM).

STUDY DESIGN

A case report.

METHODS

We present a case of a 51-year-old man who presented acute onset epigastric pain, paraplegia, and sensory loss below his nipples. Magnetic resonance imaging and selective spinal angiogram demonstrated hematomyelia, subarachnoid hemorrhage, and spinal arteriovenous fistula fed by the right Th7 intercostal artery. By laminotomy of Th6-8, the varix-like draining vein and intramedurally hematoma were partially removed and the arterial supply was interrupted by coagulation of the right Th7 segmental artery.

RESULTS

One month after surgery, he regained movement against gravity at the left ankle and toe but no functionally significant improvement.

CONCLUSIONS

It must be kept in mind that spinal dural arteriovenous fistulas (Type I spinal AVM) has possibility of hematomyelia origin, despite the fact that it is extremely rare.