• Toshinari Kawasaki, Hitoshi Fukuda, Yoshitaka Kurosaki, Akira Handa, Masaki Chin, and Sen Yamagata.
• Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan. Electronic address: toshi821@kuhp.kyoto-u.ac.jp.
• World Neurosurg. 2016 Nov 1; 95: 619.e1-619.e4.

BackgroundPatients with subarachnoid hemorrhage (SAH) by hemorrhagic arteriovenous fistulas (AVFs) usually presents with meningeal signs, including headache and nausea, and focal neurologic deficit is found in rare cases. In this article, we report a case of acute compressive cervical myelopathy caused by hemorrhagic AVF at the craniocervical junction.Case DescriptionA 73-year-old woman was transferred to our hospital for sudden headache and subsequent left hemiparesis. Head computed tomography scan showed SAH exclusively in the posterior fossa, and catheter angiography revealed a perimedullary arteriovenous fistula at the craniocervical junction as a source of the SAH. Detailed neurologic examination showed the sensory disturbance of bilateral upper extremities and bladder and rectal disturbance, suggesting concurrent cervical myelopathy. Magnetic resonance imaging of the cervical spine showed disk herniation at the C4-5 level, spinal SAH deposition above the C4-5 level, and accompanying myelomalacia. No intramedullary hemorrhage was found.ConclusionsSpinal SAH alone rarely causes focal neurologic deficit. However, this case suggests spinal SAH can cause acute compressive myelopathy when complicated with preexisting spinal canal stenosis.Copyright © 2016 Elsevier Inc. All rights reserved.

32 keywords...

hide…