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Arteriovenous
malformations in or around the spinal cord can cause cord compression, ischemia,
parenchymal hemorrhage, subarachnoid hemorrhage, or a combination. Symptoms
may include gradually progressive, ascending, or waxing and waning
segmental neurologic deficits; radicular pain; and sudden back pain
with sudden segmental neurologic deficits. Diagnosis is by MRI.
Treatment is with surgery or stereotactic radiosurgery and may include
angiographic embolization.
Arteriovenous malformations (AVMs) are the most common spinal vascular malformations. Most are thoracolumbar, posterior, and outside the cord (extramedullary). The rest are cervical or upper thoracic and often inside the cord (intramedullary). AVMs may be small and localized or may affect up to half the cord. They may compress or even replace normal spinal cord parenchyma, or they may rupture, causing focal or generalized hemorrhage.
A cutaneous angioma sometimes overlies a spinal AVM. AVMs commonly compress nerve roots, causing pain that radiates down the distribution of a nerve root (radicular pain), or compress the spinal cord, causing segmental neurologic deficits that gradually progress or that wax and wane. Combined lower and upper motor neuron deficits are common. AVMs may rupture into the spinal cord parenchyma, causing sudden, severe back pain and sudden segmental neurologic deficits. Rarely, high cervical AVMs rupture into the subarachnoid space, causing sudden and severe headache, nuchal rigidity, and impaired consciousness (see Stroke (CVA): Subarachnoid Hemorrhage (SAH)).
Spinal cord AVMs may be detected incidentally during imaging . AVMs are suspected clinically in patients with unexplained segmental neurologic deficits or subarachnoid hemorrhage, particularly those who have sudden, severe back pain or cutaneous midline angiomas. Diagnosis is by MRI, magnetic resonance angiography, selective arteriography, or, occasionally, myelography plus CT.
Surgery is indicated if spinal cord function is threatened, but expertise in specialized microtechniques is required. Stereotactic radiosurgery is helpful if the AVM is small and located in a surgically inaccessible location. Angiographic embolization occludes feeder arteries and often precedes surgical removal or stereotactic radiosurgery.
Last full review/revision January 2007 by Michael Rubin, MD
Content last modified January 2007
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