[Partially thrombosed radiculomeningeal arterio-venous fistula in spinomedullary junction].
A 58-year-old man was admitted to our hospital because of tetraparesis of fairly sudden onset. He had had difficulty in miction since 6 months earlier. MRI study showed a high intensity area in front of the medulla and a low intensity "vessel-like" shadow in front of the upper cervical region on T1-weighted image. The dorsal part of the medulla and cervical spinal cord showed diffuse low intensity signals in T1-weighted image. The intra-axial lesion appeared as high intensity signals in T2-weighted image. Angiography revealed a huge dilated vascular malformation fed by a third part of the right vertebral artery. The lesion in front of the medulla was not opacified. His neurological status progressively deteriorated, resulting in combined respiratory distress. Emergency surgery was performed only for posterior decompression. Although postoperative balloon catheterization was scheduled, he died of gastric perforation and pancreas necrosis one month after the operation. At the autopsy, it was found that the feeding artery of the AVM was branched from the junction of V3 and V4 of the right vertebral artery, where the artery penetrates the dura mater. The meningeal artery was engorged, and the radicular vein of C1 was markedly dilated due to the retrograde filling. The premedullary vessel was thrombosed, but the cervical part of the AVM showed eccentric hypertrophy of the wall and a partially organized thrombus. Intra-axially, the posterior funiculus was markedly destroyed and the spinal cord was edematous and subnecrotic.(ABSTRACT TRUNCATED AT 250 WORDS)
Oda
Y
Y
Division of Neurosurgery, Shiga Medical Center for Adult Diseases, Japan.
Konishi
T
T
Suzui
H
H
Fujimoto
N
N
Nakamura
K
K
Matsumoto
M
M
Okumura
T
T
Kang
Y
Y
Kikuchi
H
H
D002533:Cerebral Angiography; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply*; D008576:Meningeal Arteries / Q000002:abnormalities*; D008875:Middle Aged; D013116:Spinal Cord / Q000098:blood supply*; D013927:Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology