Spinal arteriovenous malformation presenting as spastic monoplegic cerebral palsy in a child.
A case of spinal arterio-venous malformation (AVM) initially diagnosed as unilateral cerebral palsy (CP) is reported. The presentation was of a long-standing spastic monoparesis of the left leg, with initial response to Botulinum toxin injections to the calf and tibialis posterior muscles. This was followed by progressive deterioration occurring over a 3-month period before further investigation and definitive diagnosis at 7 years. Imaging demonstrated a large extra-medullary spinal AVM compressing the mid-thoracic cord. This was successfully managed by embolisation with a non-adhesive polymer: ethylene-vinyl alcohol copolymer injected into the dominant feeding vessel. This case highlights the need to consider alternative diagnoses when a child with a diagnosis of CP presents with atypical clinical features such as monoparesis and has worsening or altered clinical signs. Moreover, a normal magnetic resonance imaging brain scan and the absence of ipsilateral upper limb neurological signs or functional impairment should raise suspicion even in the context of static lower limb signs. A literature review was performed on the management of spinal AVM in children and this will be is discussed.
Flett
Peter John
PJ
Royal Hobart Hospital, Hobart, Tasmania, Australia. flettp@internode.on.net
Baulderstone
David
D
Russo
Remo
R
Davies
Roger Philip
RP
D001165:Arteriovenous Malformations / Q000175:diagnosis*; D002547:Cerebral Palsy / Q000503:physiopathology*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006429:Hemiplegia / Q000503:physiopathology*; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D009128:Muscle Spasticity / Q000503:physiopathology*; D011859:Radiography; D013131:Spine / Q000098:blood supply* / Q000000981:diagnostic imaging