title: Spinal Glomus Arteriovenous Malformation Manifesting with a Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Spinal arteriovenous malformations (AVMs) are rare lesions that may cause serious neurologic morbidity. With developments in endovascular technology and embolic materials, endovascular management of spinal AVMs has gained popularity.
  
  
  METHODS
  A 61-year-old woman presented with the worst headache of her life and an acute onset of nausea and vomiting and was shown to have a grade 2 subarachnoid hemorrhage (SAH) on computed tomography scan. A 6-vessel cerebral angiogram was negative for any vascular abnormalities. Magnetic resonance imaging and magnetic resonance angiography of the neck showed a flow-related enhancement compatible with a vascular abnormality at the level of C2. Cervical spinal angiography showed a cervical spinal cord glomus (type II) AVM at the level of C2 draining into perimedullary venous plexus. Transarterial Onyx embolization was performed and resulted in complete occlusion of the AVM. The patient made a complete neurologic recovery.
  
  
  CONCLUSIONS
  Spinal AVMs manifesting as intracranial SAH are uncommon. These lesions are frequently overlooked on cerebral angiography and account for a small proportion of angiogram-negative SAHs. A negative angiogram in the setting of SAH should prompt a comprehensive evaluation of the cervical segmental arterial supply to exclude a cervical spinal AVM. Endovascular embolization may be effective in treating spinal glomus AVMs with good clinical outcomes and with complete angiographic obliteration. Onyx embolic agent should be considered as the agent of choice to manage spinal glomus AVMs.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Badih
authors.initials: B
authors.lastname: Daou
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Elias
authors.initials: E
authors.lastname: Atallah
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Fadi
authors.initials: F
authors.lastname: Al-Saiegh
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Kenan
authors.initials: K
authors.lastname: Alkhalili
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA. Electronic address: pascal.jabbour@jefferson.edu.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D001165:Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Angiogram-negative subarachnoid hemorrhage; Arteriovenous malformation; Glomus; Onyx; SAH; Spine; Subarachnoid hemorrhage