title: Acute Compressive Myelopathy Caused by Spinal Subarachnoid Hemorrhage: A Combined Effect of Asymptomatic Cervical Spondylosis.
abstract: BACKGROUND
  Patients with subarachnoid hemorrhage (SAH) by hemorrhagic arteriovenous fistulas (AVFs) usually presents with meningeal signs, including headache and nausea, and focal neurologic deficit is found in rare cases. In this article, we report a case of acute compressive cervical myelopathy caused by hemorrhagic AVF at the craniocervical junction.
  
  
  METHODS
  A 73-year-old woman was transferred to our hospital for sudden headache and subsequent left hemiparesis. Head computed tomography scan showed SAH exclusively in the posterior fossa, and catheter angiography revealed a perimedullary arteriovenous fistula at the craniocervical junction as a source of the SAH. Detailed neurologic examination showed the sensory disturbance of bilateral upper extremities and bladder and rectal disturbance, suggesting concurrent cervical myelopathy. Magnetic resonance imaging of the cervical spine showed disk herniation at the C4-5 level, spinal SAH deposition above the C4-5 level, and accompanying myelomalacia. No intramedullary hemorrhage was found.
  
  
  CONCLUSIONS
  Spinal SAH alone rarely causes focal neurologic deficit. However, this case suggests spinal SAH can cause acute compressive myelopathy when complicated with preexisting spinal canal stenosis.
authors: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan. Electronic address: toshi821@kuhp.kyoto-u.ac.jp.
authors: Toshinari
authors: T
authors: Kawasaki
authors: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors: Hitoshi
authors: H
authors: Fukuda
authors: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors: Yoshitaka
authors: Y
authors: Kurosaki
authors: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors: Akira
authors: A
authors: Handa
authors: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors: Masaki
authors: M
authors: Chin
authors: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors: Sen
authors: S
authors: Yamagata
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000000981:diagnostic imaging; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D013116:Spinal Cord / Q000098:blood supply; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology*; D055009:Spondylosis / Q000150:complications* / Q000000981:diagnostic imaging; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed
keywords: Arteriovenous fistula; Cervical spondylosis; Myelopathy; Perimedullary; Spinal subarachnoid hemorrhage