Vascular Malformations of the Spinal Cord Workup

  • Author: James S Harrop, MD; Chief Editor: Allen R Wyler, MD   more...
 
Updated: Aug 17, 2011
 

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.[5]

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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, Cervical Spine Research Society, Congress of Neurological Surgeons, and North American Spine Society

Disclosure: Depuy spine Consulting fee Consulting; Geron None None; Neural Stem None None; Axiomed Ownership interest None; Stryker Spine Honoraria None

Coauthor(s)

Corey E Cheresnick  Jefferson Medical College of Thomas Jefferson University

Disclosure: Nothing to disclose.

Aaron S Dumont, MD  Associate Professor, Department of Neurological Surgery, Jefferson Medical College of Thomas Jefferson University; Director, Division of Neurovascular and Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University Hospital

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

Disclosure: Nothing to disclose.

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.

Specialty Editor Board

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, Congress of Neurological Surgeons, and World Society for Stereotactic and Functional Neurosurgery

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Allen R Wyler, MD  Former Medical Director, Northstar Neuroscience, Inc

Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD  Former Medical Director, Northstar Neuroscience, Inc

Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Jennifer Malone, MD, and Gregory J Przybylski, MD, to the development and writing of this article.

References

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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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