Vascular Malformations of the Spinal Cord Workup

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

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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