Spontaneous intracranial hemorrhage and obstructive hydrocephalus: unusual complications of a cervical intramedullary arteriovenous malformation.
A case of acute severe noncommunicating hydrocephalus complicating a high cervical arteriovenous malformation (AVM) is presented here. A 29-year-old lady, 4 years after partial microsurgical resection of a high cervical intramedullary AVM, presented with sudden-onset weakness of all extremities, impaired cognition, cervical/occipital pains, and bisphincteric dysfunction. She was drowsy but arousable with a Glasgow coma scale score of 14. She had spastic quadriparesis and cognitive impairment. Cranial computerized tomographic scan showed marked panventriculomegaly. There was some blood residue in the posterior horn of the right lateral ventricle and transependymal spread of cerebrospinal fluid (CSF) indicative of the subacute/chronic nature of the obstruction to the CSF circulation. Cervical spine magnetic resonance imaging also showed the residual upper cervical AVM. She had an emergency ventriculoperitoneal shunting with good neurologic outcome. Spinal AVMs may present with unusual intracranial hemorrhagic complications. Attending physicians should always be mindful of this fact in the total clinical evaluations of each case.
Adeleye
Amos O
AO
Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria. femdoy@yahoo.com
Rabiu
Taopheeq B
TB
Malomo
Adefolarin O
AO
D000328:Adult; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000175:diagnosis; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D013116:Spinal Cord / Q000098:blood supply*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt