Subarachnoid Hemorrhage Secondary to Spinal Arteriovenous Malformation and Aneurysm

Caroscio, James T.; Brannan, Timothy; Budabin, Murray; Huang, Yun Peng; Yahr, Melvin D.

doi:10.1001/archneur.1980.00500510059011

Cited by 73 publications

(20 citation statements)

References 19 publications

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“…On the other hand, definite proof of subarachnoid hemorrhage was received in only three of 50 cases of angiographically proven spinal AVM (6%), all of which showed combination with arterial aneurysm [104]. This combination is welldocumented in both the brain [188,243] and the spinal cord [34,110,112,143,190,192] and has been observed in two among 33 morphologically proven spinal intradural AVMs of our series ( Figure 3E). The saccular aneurysms, always found in intimate association with a spinal AVM, are located on the main vessel feeding the malformation [55], a condition somewhat similar to the finding in intracranial AVMs associated with aneurysm [223].…”

Section: Morphologic Typesmentioning

confidence: 53%

“…Acute or recurrent subarachnoid hemorrhage has been reported in 10-40% of several series of spinal angiomas [2,14,34,60,113,139,177,181,192,193,224] which have been said to be the most common cause of subarachnoid bleeding to the spinal theca [7,11,84,102,110,152,153,177,190,192,193,259]. Spinal subarachnoid hemorrhages are met with all types of angiomas, most frequently with AVMs, where their incidence is greater in AVMs with a large shunt than from those with smaller ones [2,192].…”

Section: Morphologic Typesmentioning

confidence: 99%

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Vascular malformations of the central nervous system: A morphological overview

Jellinger

1986

Neurosurg. Rev.

244

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Vascular malformations of the central nervous system (C.N.S.) are classified by size, location, and morphologic type, distinguishing capillary telangiectasias, cavernous malformations, venous angiomas, arteriovenous malformations (AVMs) including varix of the great vein of Galen, and other vascular malformations (e.g. Sturge-Weber syndrome). The morphology and predominant location pattern of the different types of vascular malformations in the brain and spinal cord, and their embryology are reviewed. In the brain and its coverings, all types mainly AVMs and venous angiomas do occur, representing 5-9% of all intracranial space-occupying lesions and 20-40% of the sources of surgically treated intracranial hemorrhages. 50-80% of the angiomas are located in the cerebral hemispheres, 10-18% in central brain areas (basal ganglia, internal capsule, choroid plexus), and 10-30% in the posterior fossa. The major types of cerebral vascular malformations are described with reference to their anatomical features, location, chief arterial and venous supply, and prominent complications. Spinal vascular malformations, accounting for 3 to 12% of spinal space-occupying lesions, include vertebral, extradural, dural, subpial and intramedullary angiomas which occur as isolated or complex vascular anomalies and may involve various covering layers at the same level. The preferential occurrence of angiomas on the dorsal surface of the cord and in the caudal regions is related to the embryologic development of spinal vasculature. Frequent association of spinal angiomas (20-25%) with other vascular anomalies and dysplasias emphasizes their hamartomatous nature and developmental origin. Spinal angiomas include capillary telangiectasias with extra- or intradural and, rarely, intramedullary location, cavernomas, mainly arising in vertebral bodies, venous angiomas, mainly located in vertebral bodies and in the extradural space, and AVMs constituting the commonest type, that may affect both the pial and radicular vessels and can penetrate into the cord. They present as simple AV fistulas, cirsoid angiomas with localized vascular plexuses and large complex convolutions ("juvenile" type). The complications of spinal angiomas include subarachnoid hemorrhage, rare epidural hematoma, hematomyelia, compression lesions of the cord and roots, and ischemic changes causing chronic progressive radiculomyelopathy, previously referred to as Foix-Alajouanine syndrome. Chronic damage to the cord and spinal roots results from pressure effects, thrombosis of the abnormal vessels, disorders of venous drainage, and "steal" phenomena related to the vascular anomalies.

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Section: Morphologic Typesmentioning

confidence: 53%

Section: Morphologic Typesmentioning

confidence: 99%

Vascular malformations of the central nervous system: A morphological overview

Jellinger

1986

Neurosurg. Rev.

244

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“…In 48 patients (42.5%) the SAs were associated with an AVM (Table 2). 8,9,14,18,20,23,34,39,42,44,49,52,55,57,61,62,[64][65][66]76,82,85,87,91,96,97,105 In terms of the number of aneurysms, 55 (44.7%) were associated with an AVM and 68 (55.3%) were isolated spinal aneurysms (iSA) not associated with an AVM (Table 3). 2,4-7,11,12,15-17,21,22,24,25,27,28,30,32,33,35,37,41,43,45-48,50,54,56,58,60,68-70, 72-75,78-80,83,84,86,88,90,93,95,98-104,106-108 The mean age of patients who had an SA-AVM was 23.3 ± 16.9 years and that of patients with an iSA was 49.3 ± 17.8 years.…”

Section: Epidemiological Characteristicsmentioning

confidence: 99%

Spinal aneurysms: clinicoradiological features and management paradigms

Madhugiri

Ambekar

Kumar

et al. 2013

SPI

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Object Spinal aneurysms (SAs) are rare lesions. The clinicoradiological features and the exact degree of their association with comorbid conditions such as arteriovenous malformations (AVMs) and coarctation of the aorta have not been definitively described. The ideal management paradigm has not been established. The authors reviewed literature to determine the clinical patterns of presentation, management, and outcome of spinal aneurysms. Methods A systematic review of literature was performed using 23 separate strings. A total of 10,190 papers were screened to identify 87 papers that met the inclusion criteria. A total of 123 SAs could be included for analysis. Results The mean age of patients at presentation was 38 years; 10% of patients were aged less than 10 years and nearly 50% were greater than 38 years. Spinal aneurysms can be divided into 2 groups: those associated with AVMs (SA-AVMs, or Type 1 SAs) and those with isolated aneurysms (iSAs, or Type 2 SAs). Patients with Type 2 SAs were older and more likely to present with bleeding than those with Type 1 SAs. The acute syndromes can be divided into 3 groups of patients: those with spinal syndrome, those with cranial/craniospinal syndrome, and those with nonspecific presentation. Overall, 32.6% presented with angiography-negative cranial subarachnoid hemorrhage (SAH). Presentation with evidence of cord dysfunction (myelopathy/weakness/sensory loss/bladder involvement) correlated with poor outcome, as did presentation with hemorrhage and association with other comorbid conditions. Surgery and endovascular therapy both led to comparable rates of complete aneurysm obliteration for Type 2 SAs, whereas for the AVM-associated Type 1 SAs, surgery led to better rates of lesion obliteration. The authors propose a classification scheme for spinal aneurysms based on whether the lesion is solitary or is associated with a coexistent spinal AVM; this would also imply that the ideal therapy for the aneurysm would differ based on this association. Conclusions The clinical and radiological patterns that influence outcome are distinct for Type 1 and Type 2 SAs. The ideal treatment for Type 1 SAs appears to be excision, whereas surgery and endovascular therapy were equally effective for Type 2 SAs.

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“…In the subgroup of patients with subarachnoid spinal hemorrhage, 34 of 96 (35.4%) cases showed cerebral symptoms resembling cerebral hemorrhage [3]. Caroscio et al reviewed another collection of 50 cases of spinal subarachnoid hemorrhage and found that intracranial symptoms or signs were present in 80% of patients [8]. When present, these symptoms often hide spinal symptoms and lead to misdiagnoses.…”

Section: Discussionmentioning

confidence: 99%

Spinal Hemorrhage Leading to Cerebral Vasospasm and Infarction

2012

J Neurol Res

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Only one case of intracranial arterial vasospasm resulting cerebral infarction was previously described in the setting of spinal hemorrhage. The speculation of such symptomatic vasospasm being caused by an intracranial extension of the spinal hemorrhage has been unproven. Here we describe two patients with extensive spinal hemorrhage demonstrated on spinal magnetic resonance imaging (MRI). During their subsequent course, both patients developed cranial signs that included encephalopathy, visual deficit and aphasia. In both cases, small amount of intracranial hemorrhage was detected on head imaging, representing an extension of the spinal hemorrhage. Multiple areas of acute ischemia were seen on brain MRI in both patients. On digital subtraction angiography, diffuse vasospasm of carotid and vertebrobasilar arteries was seen which became normalized prior to discharge. Our report suggests that in treating patients with spinal hemorrhage, physicians need to be aware of possible intracranial hemorrhagic extension and subsequent cerebral vasospasm leading to ischemia. As symptoms of intracranial origin are commonly seen in patients with spinal hemorrhage, the incidence of cerebral vasospasm in this setting could be underestimated.

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Subarachnoid Hemorrhage Secondary to Spinal Arteriovenous Malformation and Aneurysm

Cited by 73 publications

References 19 publications

Vascular malformations of the central nervous system: A morphological overview

Vascular malformations of the central nervous system: A morphological overview

Spinal aneurysms: clinicoradiological features and management paradigms

Spinal Hemorrhage Leading to Cerebral Vasospasm and Infarction

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