The pathophysiology of spinal vascular malformations

Aminoff, M. J.; Barnard, Rita; Logue, Valentine

doi:10.1016/0022-510x(74)90229-9

Cited by 293 publications

(116 citation statements)

References 14 publications

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“…2,30 Intramedullary fistulas, which are rare, often present with hemorrhage. 12 The underlying pathophysiologic mechanism of the myelopathy induced by arteriovenous fistulas is now believed to involve passive venous congestion of the cord, [1][2][3][4]31 because arterial blood originating from the fistula enters the perimedullary venous plexus, a valveless system, increasing pressure and impairing normal drainage from the cord parenchyma. The preferential involvement of the distal spinal cord, even when the fistula itself is identified several levels above the lesion, presumably is due to orthostasis.…”

Section: Discussionmentioning

confidence: 99%

“…7 It was not until the 1970s, with continuous improvement in radiologic imaging, that the etiology of the majority of the cases was ascribed to a spinal dural arteriovenous fistula draining into intradural medullary veins. 1,2 Large series of patients with this condition have been reported in recent decades. 11,12,23 and their clinicoradiologic characteristics and therapeutic approaches have been well studied.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] The primary vascular pathology often lies outside the spinal cord. The secondary changes occurring in the spinal parenchyma, however, histologically can mimic an intraspinal vascular malformation or even a neoplasm.…”

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confidence: 99%

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Venous congestive myelopathy: a mimic of neoplasia

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Venous congestive myelopathy: a mimic of neoplasia

et al. 2005

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“…17 Acute presentations are usually attributable to infarction or acute hemorrhage causing cord compression. Our patient had a sudden change in fetal activity 2 days before delivery, probably caused by infarction.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic intrauterine spinal cord injury caused by an arteriovenous malformation

2007

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We report a baby born with flaccid quadraparesis that was considered possibly attributable to birth injury. Postmortem examination identified an injury that occurred well before delivery caused by hemorrhage from an arteriovenous malformation of the brainstem and spinal cord. We discuss imaging modalities to diagnose neonatal cord injuries, possible treatments, prognosis and end of life decision making for these unfortunate patients. We also emphasize the importance of the autopsy in cases of suspected birth injury.

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“…[13][14][15][16] Surgical studies have shown that interruption of the shunt halts progression and can lead to functional improvement in a substantial proportion of patients, implying that the clinical dysfunction was due to venous congestion. 17 Pathological studies of spinal tissue associated with a spinal dural arteriovenous fistula (AVF) have shown marked white matter hypocellularity and small vessels with thickened, hyalinized walls.…”

Section: Introductionmentioning

confidence: 99%

Venous hypertensive myelopathy as a potential mimic of transverse myelitis

Krishnan

Malík²,

Kerr

2004

Spinal Cord

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Study design: Case report. Objective: We describe a patient who developed a myelopathy associated with a noncompressive herniated cervical intervertebral disc at the same level. We provide clinical and radiological evidence that reveals that even though the disc herniation did not compress the spinal cord, it diminished venous blood flow out of the spinal cord, possibly resulting in a venous hypertensive myelopathy (VHM). Setting: Baltimore, MD, USA. Clinical presentation: A 29-year-old woman developed a cervical radiculopathy, followed by a slowly progressive cervical myelopathy associated with a herniated C5-C6 disc. Magnetic resonance imaging showed a noncompressive disc herniation, a swollen spinal cord with increased T2 signal most prominent at the site of the herniated disc, extending several levels above and below the disc. The patient was diagnosed with acute transverse myelitis (ATM) and was started on IV steroids. However, unlike most cases of transverse myelitis, spinal fluid analysis was noninflammatory. In contrast, several features suggested that the patient instead had VHM. We suggest that the disc herniation resulted in impaired drainage of blood from the spinal cord through compression of the venous plexus near the intervertebral foramen. Intervention: Although the patient did not recover function following high-dose steroid administration, she recovered completely following C5-C6 discectomy and fusion. Conclusion: To our knowledge, this is the first report of likely VHM in the absence of a spinal arteriovenous malformation. We suggest that some patients diagnosed with ATM in the setting of extrinsic spinal column abnormalities may actually have a noninflammatory myelopathy associated with impaired spinal venous drainage.

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The pathophysiology of spinal vascular malformations

Cited by 293 publications

References 14 publications

Venous congestive myelopathy: a mimic of neoplasia

Venous congestive myelopathy: a mimic of neoplasia

Catastrophic intrauterine spinal cord injury caused by an arteriovenous malformation

Venous hypertensive myelopathy as a potential mimic of transverse myelitis

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