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Vascular Malformations of the Spinal Cord Workup

  • Author: James S Harrop, MD; Chief Editor: Brian H Kopell, MD  more...
 
Updated: Feb 17, 2016
 

Laboratory Studies

No laboratory studies are useful for the diagnosis of spinal cord vascular malformations. However, if the patient presents with symptoms of subarachnoid hemorrhage, a lumbar puncture or CT scan demonstrates blood in the spinal fluid.

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Imaging Studies

Plain radiography is not usually helpful for diagnosis.

CT scanning may demonstrate dilated vessels in the thecal sac, but findings are usually normal. If a patient presents with symptoms of subarachnoid hemorrhage, CT scanning demonstrates blood in the spinal fluid.

Myelography findings, with or without CT, show dilated vessels in the intradural space. This imaging modality is very sensitive and shows these abnormalities in detail. This is an invasive procedure that requires injection of a contrast agent into the thecal sac. Postprocedure headaches are not uncommon.

MRI is a noninvasive imaging modality. The soft tissue and neural elements are visualized in detail with this technique. Dilated intradural vessels can be seen as flow voids or can be seen filling with contrast. Edema or hemorrhage in the spinal cord parenchyma can be assessed. The exact fistula site cannot be localized.

MRA or CTA are noninvasive modalities being used to identify any abnormal vessels. However, the resolution of these modalities is not to yet high enough.

Arteriography is the criterion standard modality for visualizing arteriovenous malformations (AVMs). This is a dynamic study that allows visualization of the pathology in real time, allowing assessment of high-flow versus low-flow AVMs. In addition, the location of the fistula can be visualized. Arteriography is an invasive procedure that may cause morbidity such as spinal cord ischemia, cerebral vascular accident, and vascular dissection.

Typically, a spinal MRI is ordered as a first-line screening method to detect spinal vascular malformations. If a spinal vascular malformation is still suspected, digital subtraction angiography (DSA) must be performed to display the very small vessels of the spinal cord. Owing to the complications involved with DSA, an MRA or CTA can be used to determine the spinal cord level of the feeding artery and thus limit the amount of time it takes to perform the DSA procedure.[6]

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Diagnostic Procedures

If the patient presents with symptoms of subarachnoid hemorrhage, a lumbar puncture demonstrates blood in the spinal fluid.

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Contributor Information and Disclosures
Author

James S Harrop, MD Associate Professor, Departments of Neurological and Orthopedic Surgery, Jefferson Medical College of Thomas Jefferson University

James S Harrop, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Spinal Injury Association, North American Spine Society, Congress of Neurological Surgeons, Cervical Spine Research Society

Disclosure: Received consulting fee from Depuy spine for consulting; Received none from Geron for none; Received none from Neural Stem for none; Received ownership interest from Axiomed for none; Received honoraria from Stryker Spine for none.

Coauthor(s)

James W Pritchett, MD Chief of Orthopedic Surgery, Swedish Orthopedic Institute; Active Staff, Swedish Medical Center

James W Pritchett, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, Washington State Medical Association, Association of Bone and Joint Surgeons

Disclosure: Nothing to disclose.

Corey E Cheresnick Jefferson Medical College of Thomas Jefferson University

Disclosure: Nothing to disclose.

Aaron S Dumont, MD Charles B Wilson Professor and Chairman, Department of Neurological Surgery, Tulane University School of Medicine

Aaron S Dumont, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, North American Skull Base Society, Society of NeuroInterventional Surgery, Neurocritical Care Society

Disclosure: Nothing to disclose.

George M Ghobrial, MD Resident Physician, Department of Neurological Surgery, Thomas Jefferson University Hospital

Disclosure: Nothing to disclose.

Tristan B Fried Student Medical Researcher, Thomas Jefferson Hospital; Student Researcher (STAR), Department of Dermatology, Hahnemann University

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai

Brian H Kopell, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, International Parkinson and Movement Disorder Society, Congress of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, North American Neuromodulation Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from St Jude Neuromodulation for consulting; Received consulting fee from MRI Interventions for consulting.

Additional Contributors

Paul L Penar, MD, FACS Professor, Department of Surgery, Division of Neurosurgery, Director, Functional Neurosurgery and Radiosurgery Programs, University of Vermont College of Medicine

Paul L Penar, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, World Society for Stereotactic and Functional Neurosurgery, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

Pascal M Jabbour, MD Cerebrovascular Fellowship, Department of Neurosurgery, Thomas Jefferson University Hospital

Pascal M Jabbour, MD is a member of the following medical societies: Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Jennifer Malone, RN Department of Neurosurgery, Jefferson Medical College

Disclosure: Nothing to disclose.

Gregory J Przybylski, MD Professor of Neurological Surgery, Seton Hall University, School of Graduate Medical Education; Director of Neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center

Disclosure: Nothing to disclose.

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Spinal malformation. This is a sagittal T2-weighted MRI of the thoracic spine of a 68-year-old woman with a 9-month history of back pain and sensory loss, progressing to the point of loss of bowel and bladder function along with a sudden onset of paraparesis. Note the thoracolumbar junction with an edematous spinal cord and dilated serpiginous intradural venous plexus.
Spinal malformation. This is an axial T2-weighted MRI of the thoracic spine of a 68-year-old woman with a 9-month history of back pain and sensory loss, progressing to the point of loss of bowel and bladder function along with a sudden onset of paraparesis. Note the lumbar spine with an edematous spinal cord and dilated intradural venous plexus.
 
 
 
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