Ruptured spinal arteriovenous malformation leading to Paraplegia in Pregnancy: Case report
Dr Royal Brisbane and Women's Hospital, Australia has reported a rare case of Ruptured spinal arteriovenous malformation leading to Paraplegia in Pregnancy. The case has appeared in the Case Reports in Obstetrics and Gynecology.
Ruptured spinal arteriovenous malformation (AVM) is a rare cause of paraplegia in pregnancy, with only a few case reports describing complications from spinal AVMs during pregnancy in the literature.
A 32-year-old woman presented at 37 weeks gestation with back pain and rapidly progressive lower limb neurological symptoms. MRI showed a previously undiagnosed spinal AVM at T8. A healthy girl was delivered by caesarean under general anaesthesia to facilitate further investigation. After spinal angiography, it was concluded the most likely aetiology was an acute rupture of an intra- and perimedullary AVM with associated haemorrhage at T8 secondary to venous compression from the enlarged uterus at L5 causing high pressure within the AVM and subsequent rupture. The neurosurgical and interventional radiology teams felt the lesion was not amenable to surgical or endovascular intervention. The patient remained paraplegic with no sign of neurological recovery six months after delivery.
While new onset paraplegia during pregnancy secondary to ruptured spinal AVM is very rare, it is important to discuss these cases to inform future practice. In contrast to previous case reports, our patient did not spontaneously recover after delivery and was not amenable to surgical or endovascular treatment.
Spinal vascular malformations, including arteriovenous malformations (AVMs), are rare. Prompt diagnosis and treatment may prevent long-term neurological disability. Patients with spinal AVMs usually present with back pain and progressive myelopathy with gait disturbance, sensory changes, and bladder or bowel symptoms. Proposed mechanisms for neurological deterioration include haemorrhage, redistribution of blood supply ("steal phenomena"), mass effect, or venous congestion. Treatment options include embolisation, surgery, combined embolisation, and surgery, or conservative management depending on the specific lesion.
Ruptured spinal AVM is a rare cause of paraplegia in pregnancy, with only a few case reports describing complications from spinal vascular malformations during pregnancy in the literature. The physiological changes of pregnancy, as well as compression of venous outflow by the gravid uterus, make pregnant women particularly susceptible to complications of spinal vascular malformations, precipitating venous congestion or rupture and subsequent neurological symptoms. This case describes a pregnant woman with rapidly progressive paraplegia secondary to a previously undiagnosed spinal AVM at the eighth thoracic (T8) level that ruptured during late pregnancy.
For more details click on the link: https://doi.org/10.1155/2018/6096483
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