Kawasaki Toshinari, Fukuda Hitoshi, Kurosaki Yoshitaka, Handa Akira, Chin Masaki, Yamagata Sen
Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
World Neurosurg. 2016 Nov;95:619.e1-619.e4. doi: 10.1016/j.wneu.2016.08.031. Epub 2016 Aug 25.
Patients with subarachnoid hemorrhage (SAH) by hemorrhagic arteriovenous fistulas (AVFs) usually presents with meningeal signs, including headache and nausea, and focal neurologic deficit is found in rare cases. In this article, we report a case of acute compressive cervical myelopathy caused by hemorrhagic AVF at the craniocervical junction.
A 73-year-old woman was transferred to our hospital for sudden headache and subsequent left hemiparesis. Head computed tomography scan showed SAH exclusively in the posterior fossa, and catheter angiography revealed a perimedullary arteriovenous fistula at the craniocervical junction as a source of the SAH. Detailed neurologic examination showed the sensory disturbance of bilateral upper extremities and bladder and rectal disturbance, suggesting concurrent cervical myelopathy. Magnetic resonance imaging of the cervical spine showed disk herniation at the C4-5 level, spinal SAH deposition above the C4-5 level, and accompanying myelomalacia. No intramedullary hemorrhage was found.
Spinal SAH alone rarely causes focal neurologic deficit. However, this case suggests spinal SAH can cause acute compressive myelopathy when complicated with preexisting spinal canal stenosis.
出血性动静脉瘘（AVF）导致的蛛网膜下腔出血（SAH）患者通常表现为脑膜刺激征，包括头痛和恶心，罕见情况下会出现局灶性神经功能缺损。在本文中，我们报告了一例颅颈交界处出血性AVF导致急性压迫性颈髓病的病例。
一名73岁女性因突发头痛及随后出现左侧偏瘫被转诊至我院。头颅计算机断层扫描显示仅在后颅窝有SAH，导管血管造影显示颅颈交界处髓周动静脉瘘是SAH的来源。详细的神经系统检查显示双侧上肢感觉障碍以及膀胱和直肠功能障碍，提示合并颈髓病。颈椎磁共振成像显示C4-5水平椎间盘突出，C4-5水平以上脊髓SAH沉积以及伴随的脊髓软化。未发现髓内出血。
单纯脊髓SAH很少导致局灶性神经功能缺损。然而，该病例提示当脊髓SAH合并存在的椎管狭窄时可导致急性压迫性脊髓病。
