title: Traumatic Spinal Perimedullary Arteriovenous Fistula Induced by a Cervical Glass Stab Injury.
abstract: BACKGROUND
  In the literature, perimedullary arteriovenous fistula (AVF) is an uncommon spinal vascular malformation that is generally regarded as a congenital lesion. To our knowledge, only a few cases of traumatic perimedullary AVF have been reported in the literature so far.
  
  
  METHODS
  A 58-year-old man presented with subarachnoid hemorrhage (SAH) resulting from a secondary perimedullary arteriovenous fistula (AVF) induced by a glass stab injury to his right posterior neck. The glass had been removed, and the lacerated dura mater was closed. Hydrocephalus was diagnosed 2 months later, and the patient underwent ventriculoperitoneal shunt placement. Magnetic resonance imaging and digital subtraction angiography subsequently revealed dissection of the extradural right vertebral artery. However, there were no signs of perimedullary AVF. The patient presented 9 months after injury with sudden onset of severe headache, and SAH was diagnosed. Repeat digital subtraction angiography showed that the right vertebral artery dissection remained unchanged and was unlikely to be the underlying cause of SAH. However, a new diagnosis of perimedullary AVF at the craniocervical junction was made, and this was considered as a potential cause of SAH. The lesion was surgically obliterated. The hemosiderin deposits on the surface of the spinal cord confirmed that perimedullary AVF was the origin of SAH.
  
  
  CONCLUSIONS
  Cervical trauma should be considered as a possible cause of de novo perimedullary AVF. Recognition of this phenomenon is important.
authors.affiliation: Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Ogita
authors.affiliation: Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurosurgery, Kohnan Hospital, Sendai, Japan. Electronic address: endo@nsg.med.tohoku.ac.jp.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Endo
authors.affiliation: Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Endo
authors.affiliation: Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000601:surgery*; D000072226:Computed Tomography Angiography; D005898:Glass; D006801:Humans; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D013116:Spinal Cord / Q000098:blood supply*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000601:surgery; D014951:Wounds, Stab / Q000150:complications*
keywords: Cervical trauma; Perimedullary arteriovenous fistula; Subarachnoid hemorrhage