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Spine
Case report
A lumbar arteriovenous fistula presenting with intraventricular hemorrhage and hydrocephalus
  1. Brandon A Miller1,
  2. Robert Christopher Spears1,
  3. Thomas K Hines1,
  4. Abdulnasser Alhajeri2 and
  5. Justin F Fraser2
  1. 1 Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
  2. 2 Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
  1. Correspondence to Dr Brandon A Miller; brandonmiller{at}uky.edu

Abstract

Pediatric spinal vascular malformations are rare entities that typically present with symptoms from their effect on surrounding structures. Here we report a unique case of lumbar spinal dural/perimedullary arteriovenous fistula (AVF) that presented with intraventricular hemorrhage and hydrocephalus. The previously healthy child presented with lethargy and headache, and initial imaging revealed only ventriculomegaly with trace intraventricular blood. His mental status improved with CSF diversion via an external ventricular drain. Further workup revealed a spinal AVF that was treated via endovascular embolization. His course was complicated by vasospasm requiring endovascular treatment and he eventually required ventriculoperitoneal shunt placement. He made a full recovery and has returned to his normal activities. This is a unique case of spinal AVF presentation and highlights the importance of considering imaging of the entire neuroaxis during workup for hydrocephalus.

  • hydrocephalus
  • fistula
  • pediatrics

https://doi.org/10.1136/bcr-2019-015631

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    Footnotes

    • Contributors BAM, AA and JFF directed management of the patient and planned the manuscript. BAM completed the initial drafting of the manuscript. Initial revisions were completed by RCS. TKH prepared the figures. All authors critically reviewed and revised the manuscript for its final draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.