Departments of Neurosurgery.
J Neurosurg Spine. 2014 Mar;20(3):322-6. doi: 10.3171/2013.12.SPINE12163. Epub 2014 Jan 10.
The authors report on a 49-year-old man with a thoracic spinal dural arteriovenous shunt (dAVS) in which rupture of a varix caused intramedullary hemorrhage. In the literature, patients with a thoracic dAVS predominantly present with congestive myelopathy; however, the patient featured in this report presented without increased deep tendon reflexes or muscle weakness, but instead with intermittent stabbing chest pain and paresthesia. Magnetic resonance images and angiograms demonstrated tortuous enlargement and the formation of a varix-like structure of the draining veins, features compatible with those of high-flow angiopathy. Recognition of this phenomenon is important in thoracic dAVS because intramedullary hemorrhage dramatically degrades outcome. A high index of clinical suspicion can prevent a similar case of thoracic dAVS from progressing to intramedullary hemorrhage.
作者报告了一例 49 岁男性胸椎管内硬脊膜动静脉瘘（dAVS），其静脉瘤破裂导致脊髓内出血。在文献中，胸椎管内 dAVS 的患者主要表现为充血性脊髓病；然而，本报告中的患者没有出现深腱反射亢进或肌肉无力，而是间歇性刺痛胸痛和感觉异常。磁共振成像和血管造影显示引流静脉迂曲扩张并形成类似静脉瘤样结构，这些特征与高流量血管病相符。这种现象在胸椎管内 dAVS 中很重要，因为脊髓内出血会显著降低预后。高临床怀疑指数可以防止类似的胸椎管内 dAVS 进展为脊髓内出血。
