1/92. De novo development of a cavernous malformation of the spinal cord following spinal axis radiation. Case report.Analysis of recent reports has suggested that cavernous malformations (CMs) of the brain may have an acquired pathogenesis and a dynamic pathophysiological composition, with documented appearance of new lesions in familial cases and following radiotherapy. The authors report the first case of demonstrated de novo formation of an intramedullary CM following spinal radiation therapy. A 17 year-old boy presented with diabetes insipidus and delayed puberty. Evaluation of endocrine levels revealed hypopituitarism, and magnetic resonance (MR) imaging demonstrated an infundibular mass. The patient underwent a pterional craniotomy and removal of an infundibular germinoma. The MR image of the spine demonstrated normal results. The patient received craniospinal radiation therapy and did well. He presented 5 years later with acute onset of back pain, lower-extremity weakness and numbness, and difficulty with urination. An MR image obtained of the spine revealed an intramedullary T-7 lesion; its signal characteristics were consistent with a CM. The patient was initially managed conservatively but developed progressive myelopathy and partial brown-sequard syndrome. Although he received high-dose steroids and bed rest, his symptoms worsened. He underwent a costotransversectomy and excision of a hemorrhagic vascular lesion via an anterolateral myelotomy. Pathological examination confirmed features of a CM. The patient has done well and was walking without assistance within 4 weeks of surgery. De novo genesis of CMs may be associated with prior radiation therapy to the spinal cord.- - - - - - - - - - ranking = 1keywords = back pain, back (Clic here for more details about this article) |
2/92. Subdural hematoma from a Type I spinal arteriovenous malformation. Case report.The authors report a patient in whom a subdural hematoma developed from a Type I spinal arteriovenous malformation (AVM). The patient became symptomatic with back pain, and magnetic resonance imaging revealed a spinal subdural hematoma. Selective spinal angiography, however, failed to demonstrate a pathological process. The patient underwent exploratory laminoplasty that revealed a subdural extraarachnoid hematoma with an underlying Type I spinal AVM, which was surgically obliterated. The patient recovered completely. Subdural hematomas that affect the spine are rare. Although a negative result was obtained using selective spinal angiography, exploratory surgery should be considered for the evacuation of a subdural hematoma and possibly for the definitive treatment of a spinal AVM.- - - - - - - - - - ranking = 1keywords = back pain, back (Clic here for more details about this article) |
3/92. Intraventricular hemorrhage as a false localizing sign of a thoracolumbar arteriovenous malformation: case report.BACKGROUND: Spinal arteriovenous malformation (SAVM) is a relatively rare disease characterized by a high incidence of intramedullary and subarachnoid haemorrhage. When the hemorrhage is profuse and the SAVM is in the cervical region the symptoms (disturbance of consciousness, papilledema, cranial nerve palsies, and convulsions) may be so severe and rapid in their onset that they may be mistaken for intracranial hemorrhage. We report here on a patient with a SAVM at T10-12, which bled intracranially, mainly intraventricularly, and resulted first in respiratory arrest and unconsciousness. CASE DESCRIPTION: The patient had been well until he was 28 years old when, during intercourse, he suffered a terrible headache and suddenly lost consciousness, with a transient respiratory arrest. He was also noted to have right hemiparesis. A computed tomography scan demonstrated intraventricular hemorrhage. After a 24-hour period of artificial ventilation the patient regained consciousness and the right arm paresis completely recovered, but a gradual worsening of the motor function of the left leg developed. Digital subtraction angiography did not demonstrate any intracranial source of bleeding, whereas spinal angiography revealed a SAVM located at the medullary cone, which was totally removed by surgery. CONCLUSION: The case reported here raises several important issues. First, the advisability of spinal magnetic resonance imaging in the investigation of intraventricular (and subarachnoid) hemorrhage in patients with no demonstrable intracranial source. Secondly, the benefits of early diagnosis and reestablishment of the spinal cord circulation before the onset of thrombosis and the progressive phase of myelopathy. Finally, the necessity of complete obliteration and treatment of SAVMs even in patients with fixed neurologic deficits, because rebleeding of lower thoracic or lumbar SAVMs can lead to impairment at a higher level with severe or lethal consequences.- - - - - - - - - - ranking = 1.1880493820734keywords = headache (Clic here for more details about this article) |
4/92. Multiple cerebral arteriovenous malformations (AVMs) associated with spinal AVM.The co-existence of multiple cerebral arteriovenous malformations (AVMs) and a spinal AVM is extremely rare. A 22-year-old man suddenly developed severe headache. Computed tomography (CT) scan showed intracerebral haemorrhage in the left occipital lobe. cerebral angiography revealed eight AVMs; four were in the right frontal lobe and two each were in the right temporal and left occipital lobe, respectively. A huge high-flow spinal AVM was found incidentally. He had no other vascular lesions such as hereditary haemorrhagic telangiectasia. A left occipital craniotomy was performed and the ruptured left occipital AVMs were removed. Further therapeutic treatment was refused. To our knowledge, except for one autopsy case, this is the first reported patient with multiple cerebral AVMs with a spinal AVM. We discuss the characteristics of this case and review reported cases with cerebral and spinal AVMs.- - - - - - - - - - ranking = 1.1880493820734keywords = headache (Clic here for more details about this article) |
5/92. Intrahepatic bilomas associated with hepatic arteriovenous malformation.A 26 year-old female presented with progressive intermittent right upper quadrant pain. Hepatic arteriovenous malformation with small intrahepatic bilomas were found. She underwent hepatic artery ligation for control of her abdominal pain. Though the abdominal pain subsided after the hepatic artery ligation, the intrahepatic bilomas progressed. It is possible that the hepatic arteriovenous malformation (AVM) might reduce blood flow to the bile duct and then induce ischemia in the peribiliary capillary plexus, thus leading to bile duct necrosis and formation of bilomas, which could be further aggravated by hepatic artery ligation.- - - - - - - - - - ranking = 1.0863649846711keywords = abdominal pain (Clic here for more details about this article) |
6/92. Pulmonary arteriovenous malformation as a cause of severe exertional dyspnoea.A 48-year-old woman presented to the respiratory clinic with progressive exertional dyspnoea and an abnormal chest radiograph. Examination revealed mucosal telangiectasia and pulmonary angiography confirmed the presence of two pulmonary arterial venous malformations (PAVM). After therapeutic coil embolisation, dyspnoea was markedly improved, and exercise tolerance increased. Comparison of exercise test responses before and after this therapeutic intervention provides new insights into the physiological mechanisms of exertional dyspnoea in this condition.- - - - - - - - - - ranking = 0.81997606981557keywords = chest (Clic here for more details about this article) |
7/92. Prenatal detection of a giant bilateral thoracic vascular lesion: prognostic evaluation and genetic aspects.We describe a giant bilateral vascular mass in the skin of the chest diagnosed by ultrasound investigation in a fetus of 20 gestational weeks. Ultrasound and colour Doppler investigations detected no signs of early congestive heart failure but rapid and excessive enlargement of the vascular mass. Indications of increased fetal blood volume were found. The fetus had additional minor anomalies. Early in utero manifestation suggests a severe vascular malformation.- - - - - - - - - - ranking = 0.81997606981557keywords = chest (Clic here for more details about this article) |
8/92. Spinal epidural hematoma caused by extradural arteriovenous malformation: a case report and review of the literature.About 330 cases of spinal epidural hematoma have been reported in the literature but few cases had pathologically proven extradural arteriovenous malformation. The authors report a case of spinal epidural hematoma caused by extradural arteriovenous malformation. The patient presented with a sudden onset of back pain followed by rapidly progressive neurological deficit. MRI was the procedure of choice for diagnosis of this lesion. Treatment was emergency surgical decompression. prognosis depends on the preoperative neurological deficit, operative interval and localization of the hematoma.- - - - - - - - - - ranking = 1keywords = back pain, back (Clic here for more details about this article) |
9/92. A case of pelvic arteriovenous malformation in a male.BACKGROUND: Congenital pelvic arteriovenous malformation (AVM) is rare especially in males. We present a case of pelvic AVM in a 38-year-old male. He was admitted to our hospital with left flank abdominal pain and painless gross hematuria. methods/DISCUSSION: Pelvic computed tomography demonstrated a homogeneous contrast-enhanced mass, 6 cm in diameter. For diagnosis, non-invasive magnetic resonance imaging (MRI) and color Doppler ultrasonography were very useful in our case. Though the treatment is controversial, we decided to monitor his clinical course.- - - - - - - - - - ranking = 0.54318249233553keywords = abdominal pain (Clic here for more details about this article) |
10/92. Tentorial meningioma encroaching the transverse sinuses and sigmoid sinus junction area associated with dural arteriovenous fistulous malformation: a case report.A 62-year-old woman was evaluated for tinnitis and headache. magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case.- - - - - - - - - - ranking = 1.1880493820734keywords = headache (Clic here for more details about this article) |
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