• Shogo Ogita, Toshiki Endo, Tomoo Inoue, Kenichi Sato, Hidenori Endo, and Teiji Tominaga.
• Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
• World Neurosurg. 2016 Dec 1; 96: 610.e9-610.e13.

BackgroundIn the literature, perimedullary arteriovenous fistula (AVF) is an uncommon spinal vascular malformation that is generally regarded as a congenital lesion. To our knowledge, only a few cases of traumatic perimedullary AVF have been reported in the literature so far.Case DescriptionA 58-year-old man presented with subarachnoid hemorrhage (SAH) resulting from a secondary perimedullary arteriovenous fistula (AVF) induced by a glass stab injury to his right posterior neck. The glass had been removed, and the lacerated dura mater was closed. Hydrocephalus was diagnosed 2 months later, and the patient underwent ventriculoperitoneal shunt placement. Magnetic resonance imaging and digital subtraction angiography subsequently revealed dissection of the extradural right vertebral artery. However, there were no signs of perimedullary AVF. The patient presented 9 months after injury with sudden onset of severe headache, and SAH was diagnosed. Repeat digital subtraction angiography showed that the right vertebral artery dissection remained unchanged and was unlikely to be the underlying cause of SAH. However, a new diagnosis of perimedullary AVF at the craniocervical junction was made, and this was considered as a potential cause of SAH. The lesion was surgically obliterated. The hemosiderin deposits on the surface of the spinal cord confirmed that perimedullary AVF was the origin of SAH.ConclusionsCervical trauma should be considered as a possible cause of de novo perimedullary AVF. Recognition of this phenomenon is important.Copyright © 2016 Elsevier Inc. All rights reserved.

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