Epidural Spinal Arteriovenous Metameric Syndrome (Cobb Syndrome) Causing Thoracic Myelopathy: A Case Report and Review of Literature.

A 26-year-old lady, with a prior history of cutaneous lesions on her mid-back, presented with features of thoracic myelopathy with progressive lower limb weakness and gait imbalance of two months duration. The Magnetic Resonance Imaging (MRI) scan was suggestive of spinal arteriovenous metameric syndrome (SAMS) with an epidural lesion from D9-L1 compressing the spinal cord. Following pre-operative embolization, the patient underwent a decompressive laminectomy and excision of the epidural lesion, after which her symptoms improved significantly. She has been followed up for 18 months without any recurrence. Spinal arteriovenous malformation (AVM) with exclusively epidural presentation is an extremely rare type of spinal arteriovenous metameric syndrome (SAMS). Combined endovascular and surgical interventions are the treatment of choice for this condition.