Ruptured Spinal Arteriovenous Malformation: A Rare Cause of Paraplegia in Pregnancy

Abstract

Background Ruptured spinal arteriovenous malformation (AVM) is a rare cause of paraplegia in pregnancy, with only a few case reports describing complications from spinal AVMs during pregnancy in the literature. Case A 32-year-old woman presented at 37 weeks gestation with back pain and rapidly progressive lower limb neurological symptoms. MRI showed a previously undiagnosed spinal AVM at T8. A healthy girl was delivered by caesarean under general anaesthesia to facilitate further investigation. After spinal angiography, it was concluded the most likely aetiology was acute rupture of an intra- and perimedullary AVM with associated haemorrhage at T8 secondary to venous compression from the enlarged uterus at L5 causing high pressure within the AVM and subsequent rupture. The neurosurgical and interventional radiology teams felt the lesion was not amenable to surgical or endovascular intervention. The patient remained paraplegic with no sign of neurological recovery six months after delivery. Conclusion While new onset paraplegia during pregnancy secondary to ruptured spinal AVM is very rare, it is important to discuss these cases to inform future practice. In contrast to previous case reports, our patient did not spontaneously recover after delivery and was not amenable to surgical or endovascular treatment.

Spinal arteriovenous malformation: A case report and review of literature

“…[ 3 4 5 ] Similarly Patchana et al and Thiele et al reported motor and organ dysfunction. [ 1 9 ] It has been postulated that the neurological sequelae may be as a result of haemorrhage, mass effect, venous congestion or redistribution of blood. [ 3 10 ] Haemorrhage was identified in the index case and possibly the cause of the neurologic deficits.…”

Ruptured Thoracolumbar Perimedullary Arteriovenous Fistula during Pregnancy Complicated by Cerebral Subarachnoid Hemorrhage and Brainstem Hematoma: A Case Report

“…It has been postulated that physiological hormonal changes associated with pregnancy, along with compression of venous outflow and augmented intravascular volume make the spinal malformation particularly susceptible to clinical manifestations due to vessel rupture or venous congestion [ 19 ]. The risk of clinical deterioration decreases after delivery and some spinal AVFs may even spontaneously regress [ 20 , 21 ]. In our case, the PMAVF ruptured in the middle of pregnancy but due to the lack of local or myelopathic symptoms, a correct diagnosis was not established at the time of the initial presentation.…”