Arteriovenous fistula of the vertebral artery in a female infant with hypotonia and cephalocorporal disproportion.
BACKGROUND
Congenital arteriovenous fistulas are exceptional in childhood and imply a therapeutic challenge.


METHODS
A 9-month-old female infant was studied for cephalocorporal disproportion, hypotonia, progressive muscular atrophy and hyperreflexia. Computed tomography of the brain and electroencephalography were normal. Electromyographic patterns suggested proximal myopathic involvement. A continuous murmur with systolic reinforcement was audible in the neck. Angioresonance detected intracranial aneurysmal dilatations behind the bulbo-medullary junction and cerebral panangiography evidenced a direct vertebrovertebral fistula with extra- and intra-cranial varices and extreme medullary compression. Occlusion of the afferent vessel to the aneurismal sack was successfully achieved with a mixture of Histoacryl and 75% lipiodol via a microcatheter.


CONCLUSIONS
Clinical signs of an arteriovenous fistula may be atypical. Considerable cephalocorporal disproportion and a bruit in the cervical or retromastoidal regions must suggest its existence. Complete obliteration with endovascular embolization permits somatic and neurological recovery.
Núñez
F
F
Pediatric Cardiology Unit, Hospital Clínico Universitario of Valencia, Valencia, Spain.
Martínez-Costa
Cecilia
C
Soler
F
F
Guijarro-Martínez
R
R
Castelló
M L
ML
Brines
J
J
D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000628:therapy; D019465:Craniofacial Abnormalities / Q000209:etiology*; D004621:Embolization, Therapeutic; D005183:Failure to Thrive / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D009123:Muscle Hypotonia / Q000209:etiology*; D013117:Spinal Cord Compression / Q000209:etiology; D014711:Vertebral Artery