Spinal arteriovenous malformations
Updates to Article Attributes
Spinal arteriovenous malformations (AVMs) are characterised by arteriovenous shunting with or without a true nidus, and includes both arteriovenous fistulae and arteriovenous malformations.
Demographics and clinical presentationEpidemiology
Different types of spinal AVM (see below) have differing age of presentation, but overall 80% present between the age 20 and 60 years3.
Clinical presentation
It is variable, ranging from the progressive myelopathy (Foix-Alajouanine syndrome), often with delayed diagnosis, to the catastrophic spinal subarachnoid haemorrhage (see: coup de poignard of Michon 3).
Pathology
Classification
Spinal AVM'sAVMs may be classified as intramedullary and extramedullary (80%) 1 and further divided into 4 angiographic types, with additional sub types 2-3 (please refer to spinal AVM classification).
Radiographic features
DSA: angiogrpahy
Angiography remains the investigation of choice, but requires meticulous technique. It is essential to remember that the site of arterial supply can be anywhere from the upper thoracic to sacral areas with little relationship to the clinical level, or visible nidus (if present).
MRI
Features include:
-
T1
- signal voids from high velocity flow
- dilated perimedullary vessels indent/scallop the cord 1
-
T2
- signal voids from high velocity flow 1
- increased cord signal due to cytotoxic oedema or myelomalacia 1
Complications
- myelopathy from venous congestion
-<p><strong>Spinal arteriovenous malformations (AVMs)</strong> are characterised by arteriovenous shunting with or without a true nidus, and includes both arteriovenous fistulae and <a href="/articles/arteriovenous-malformations">arteriovenous malformations</a>.</p><h4>Demographics and clinical presentation</h4><p>Different types of spinal AVM (see below) have differing age of presentation, but overall 80% present between the age 20 and 60 years <sup>3</sup>. Clinical presentation is variable, ranging from the progressive myelopathy (<a href="/articles/foix-alajouanine-syndrome">Foix-Alajouanine syndrome</a>), often with delayed diagnosis, to the catastrophic spinal <a href="/articles/subarachnoid-haemorrhage">subarachnoid haemorrhage</a> (see: <a href="/articles/coup-de-poignard-of-michon">coup de poignard of Michon </a><sup>3</sup>).</p><h4>Pathology</h4><h5>Classification</h5><p>Spinal AVM's may be classified as intramedullary and extramedullary (80%) <sup>1</sup> and further divided into 4 angiographic types, with additional sub types <sup>2-3</sup> (please refer to <a href="/articles/spinal-avm-classification">spinal AVM classification</a>).</p><h4>Radiographic features</h4><h5>DSA: angiogrpahy</h5><p>Angiography remains the investigation of choice, but requires meticulous technique. It is essential to remember that the site of arterial supply can be anywhere from the upper thoracic to sacral areas with little relationship to the clinical level, or visible nidus (if present).</p><h5>MRI</h5><p>Features include:</p><ul>- +<p><strong>Spinal arteriovenous malformations (AVMs)</strong> are characterised by arteriovenous shunting with or without a true nidus, and includes both arteriovenous fistulae and <a href="/articles/arteriovenous-malformations">arteriovenous malformations</a>.</p><h4>Epidemiology</h4><p>Different types of spinal AVM (see below) have differing age of presentation, but overall 80% present between the age 20 and 60 years <sup>3</sup>. </p><h4>Clinical presentation</h4><p>It is variable, ranging from the progressive myelopathy (<a href="/articles/foix-alajouanine-syndrome">Foix-Alajouanine syndrome</a>), often with delayed diagnosis, to the catastrophic spinal <a href="/articles/subarachnoid-haemorrhage">subarachnoid haemorrhage</a> (see: <a href="/articles/coup-de-poignard-of-michon">coup de poignard of Michon</a> <sup>3</sup>).</p><h4>Pathology</h4><h5>Classification</h5><p>Spinal AVMs may be classified as intramedullary and extramedullary (80%) <sup>1</sup> and further divided into 4 angiographic types, with additional sub types <sup>2-3</sup> (please refer to <a href="/articles/spinal-avm-classification">spinal AVM classification</a>).</p><h4>Radiographic features</h4><h5>DSA: angiogrpahy</h5><p>Angiography remains the investigation of choice, but requires meticulous technique. It is essential to remember that the site of arterial supply can be anywhere from the upper thoracic to sacral areas with little relationship to the clinical level, or visible nidus (if present).</p><h5>MRI</h5><p>Features include:</p><ul>
-<li>signal voids from high velocity flow</li>- +<li>
- +<a title="Flow voids" href="/articles/flow-void">signal voids</a> from high velocity flow</li>
-<li>increased cord signal due to cytotoxic oedema or myelomalacia <sup>1</sup>- +<li>increased cord signal due to cytotoxic oedema or <a title="myelomalacia" href="/articles/myelomalacia">myelomalacia</a> <sup>1</sup>
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