title: Spinal dural arteriovenous shunt presenting with intramedullary hemorrhage: case report.
abstract: The authors report on a 49-year-old man with a thoracic spinal dural arteriovenous shunt (dAVS) in which rupture of a varix caused intramedullary hemorrhage. In the literature, patients with a thoracic dAVS predominantly present with congestive myelopathy; however, the patient featured in this report presented without increased deep tendon reflexes or muscle weakness, but instead with intermittent stabbing chest pain and paresthesia. Magnetic resonance images and angiograms demonstrated tortuous enlargement and the formation of a varix-like structure of the draining veins, features compatible with those of high-flow angiopathy. Recognition of this phenomenon is important in thoracic dAVS because intramedullary hemorrhage dramatically degrades outcome. A high index of clinical suspicion can prevent a similar case of thoracic dAVS from progressing to intramedullary hemorrhage.
authors.affiliation: Departments of Neurosurgery.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Narisawa
authors.forename: Toshiki
authors.initials: T
authors.lastname: Endo
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sato
authors.forename: Mika
authors.initials: M
authors.lastname: Watanabe
authors.forename: Akira
authors.initials: A
authors.lastname: Takahashi
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D015901:Angiography, Digital Subtraction; D001165:Arteriovenous Malformations / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D004388:Dura Mater / Q000098:blood supply*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010841:Pia Mater / Q000098:blood supply*; D012422:Rupture, Spontaneous; D013116:Spinal Cord / Q000098:blood supply; D020758:Spinal Cord Vascular Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D013904:Thoracic Vertebrae; D014648:Varicose Veins / Q000150:complications* / Q000175:diagnosis / Q000601:surgery