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Kriti B, Bains A, Lahoria U, Panda A, Khera S. Violaceous plaque with lower limb paresis in an adolescent male. Pediatr Dermatol 2024; 41:753-755. [PMID: 38621692 DOI: 10.1111/pde.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Bhat Kriti
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Jodhpur, India
| | - Anupama Bains
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Jodhpur, India
| | - Utkrist Lahoria
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Jodhpur, India
| | - Ananya Panda
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Sudeep Khera
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Mansour MA, Ali H, Ayad AA. Quadriplegia in a Child With Spinal Arteriovenous Metameric Syndrome. Neurology 2023; 101:672-673. [PMID: 37596040 PMCID: PMC10585687 DOI: 10.1212/wnl.0000000000207539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/04/2023] [Indexed: 08/20/2023] Open
Affiliation(s)
- Moustafa A Mansour
- From the Department of Neurology and Neurologic Surgery (M.A.M., A.A.A.), Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Department of Neurology and Neurologic Surgery (M.A.M.), Mayo Clinic, Rochester, MN; Division of Neuro-Intensive Care (M.A.M.), Dar Al-Fouad Medical Corporation; Department of Emergency Medicine and Critical Care (M.A.M., A.A.A.); Department of Pediatrics (H.A.); and Division of Neurology and Neurodevelopmental Disorders (H.A.), Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Hassan Ali
- From the Department of Neurology and Neurologic Surgery (M.A.M., A.A.A.), Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Department of Neurology and Neurologic Surgery (M.A.M.), Mayo Clinic, Rochester, MN; Division of Neuro-Intensive Care (M.A.M.), Dar Al-Fouad Medical Corporation; Department of Emergency Medicine and Critical Care (M.A.M., A.A.A.); Department of Pediatrics (H.A.); and Division of Neurology and Neurodevelopmental Disorders (H.A.), Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmad A Ayad
- From the Department of Neurology and Neurologic Surgery (M.A.M., A.A.A.), Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Department of Neurology and Neurologic Surgery (M.A.M.), Mayo Clinic, Rochester, MN; Division of Neuro-Intensive Care (M.A.M.), Dar Al-Fouad Medical Corporation; Department of Emergency Medicine and Critical Care (M.A.M., A.A.A.); Department of Pediatrics (H.A.); and Division of Neurology and Neurodevelopmental Disorders (H.A.), Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Baba N, Horiuchi R, Yagi T, Kanemaru K, Yoshioka H, Kinouchi H. Spinal glomus AVM presenting solely with groin pain: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE22105. [PMID: 35733634 PMCID: PMC9204914 DOI: 10.3171/case22105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Spinal glomus arteriovenous malformations (AVMs) are rare and can cause neurological morbidity due to spinal hemorrhage, venous hypertension, or mass effect. OBSERVATIONS The authors presented a rare case of spinal glomus AVM presenting with groin pain due to nerve root compression by a feeder aneurysm. A 41-year-old woman was referred to the hospital with initial right groin pain that had worsened over 2 months. Magnetic resonance imaging showed intra- and extramedullary abnormal flow voids at the T11–12 level, and spinal angiography revealed an intramedullary AVM, with extramedullary protrusion of an aneurysm on the feeder vessel, which arose from the sulcal artery of the anterior spinal artery. Because compression of the right L1 nerve root by the aneurysm was the likely cause of the patient’s pain, endovascular embolization was performed. The feeder aneurysm disappeared after partial n-butyl 2-cyanoacrylate embolization, and the groin pain disappeared immediately after treatment. Her clinical status has been stable with no recurrence during 1 year of follow-up. LESSONS This is the first report of glomus-type AVM presenting with radiculopathy alone. One should not overlook the possibility of spinal AVM among patients with groin pain.
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Affiliation(s)
- Natsumi Baba
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Ryo Horiuchi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Takashi Yagi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Kazuya Kanemaru
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Hideyuki Yoshioka
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
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Prasad SN, Barman B, Singh V, Das KK. Combined endovascular and surgical management of a case of Cobb syndrome. BMJ Case Rep 2022; 15:e246821. [PMID: 35228229 PMCID: PMC8886381 DOI: 10.1136/bcr-2021-246821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
Cobb syndrome is a rare neurocutaneous disorder characterised by spinal and cutaneous vascular malformations in a metameric distribution. Managing such cases is a challenge for the interventionists and neurosurgeons as the results are often suboptimal. We describe a case of Cobb syndrome in a young male child who presented clinically with acute paraparesis and lower backache. On radiological workup, an intradural perimedullary complex spinal arteriovenous fistula was seen with presence of subarachnoid haemorrhage in the spinal canal and compressive myelopathy. There was a haemangioma in paraspinal muscles and a maculopapular cutaneous lesion in the lower back. He was treated with combined endovascular embolisation and surgical intervention and showed significant clinical improvement on follow-up.
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Affiliation(s)
- Surya Nandan Prasad
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Bapi Barman
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vivek Singh
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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5
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Putilina M, Teplova N, Dvornikov A. Cutaneomeningospinal Angiomatosis (Cobb Syndrome) in a Young Patient. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 20:888-893. [PMID: 33602108 DOI: 10.2174/1871527320666210218083550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/28/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
Abstract
Cobb Syndrome (Spinal Arteriovenous Metameric Syndrome 1-31 (SAMS 1-31)) is a rare, non-hereditary disorder. Approximately 100 cases of CS have been described to date. The actual incidence may be much higher since only symptomatic patients were documented. In particular, post mortem studies suggest a possibly higher incidence of this syndrome. The main clinical manifestations of this syndrome include skin stains of vascular nature on the torso, in combination with spinal vascular malformations localized in one and the same metameric or spinal segment. A rare diagnosis of this syndrome in patients over 18 is probably related to the fact that the disease may be asymptomatic throughout a long period of time [3], while patients may tend to disregard the skin lesions [5,6]. As a result, most publications on this pathology are based on separate case reports [7-9]. Significant variability of clinical manifestations as well as prolonged progress of the disease often cause errors in diagnosis. What follows is a case report of a young patient with Cobb Syndrome, who was admitted to a regional vascular centre with a misdiagnosis of stroke. 20 patients of young age (from 20 to 35 years old), with a diagnosis of stroke, who were admitted to a University Clinic (of the Russian National Research Medical University Named After Pirogov N.I., Moscow). Among this group of patients, a patient with Cobb syndrome was identified. Patient P., of 22 years, presented with acute, intensive cervical spinal pain, predominantly on the right, numbness and weakness in the arms and legs. About 3 weeks before admission to the hospital the patient had ARVI with a fever of up to 37.5°C: two weeks before the onset of symptoms he had undergone extirpation of 2 teeth, for which reason he spent over 2 hours in a forced position with his head thrown back (prolonged overextension in the cervical spine). Multiple skin angiomas on the chest spreading to the shoulder and scapula region. Tetraparesis up to 4 points: tetraparesis in hands with low muscle tone, low reflexes, tetraparesis in legs with high muscle tone, high reflexes. Foot clonus when causing Achilles reflexes. Tremor in the extremities. No plantar reflex pathology detected. Sensitivity disorders in the hands - "the high gloves". No pelvic disorders detected. Given the presence and exacerbation of neurological symptoms and cutaneous angiomas MRI with contrast agent of the cervical spine was recommended. MRimage of an advanced arteriovenous malformation (AVM) of the cervical spinal cord with signs of gliosis and spinal cord oedema at the С2 - С7 level. Endovascular embolization of the AVM in cervical spinal cord was performed. The treatment led to complete reversal of neurological symptoms. In the presence of skin lesions the diagnosis of CS does not present particular difficulties, so in children and young patients with skin angiomatosis it is advisable to conduct a comprehensive examination using selective spinal angiography or MR angiography to exclude arteriovenous malformations in spinal cord.
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Affiliation(s)
- Marina Putilina
- Chair of Clinical Pharmacology, Chair of Dermatology and Venereology, Russian National Research Medical University Named After Pirogov N.I., Moscow. Russian Federation
| | - Nataliya Teplova
- Chair of Clinical Pharmacology, Chair of Dermatology and Venereology, Russian National Research Medical University Named After Pirogov N.I., Moscow. Russian Federation
| | - Anton Dvornikov
- Chair of Clinical Pharmacology, Chair of Dermatology and Venereology, Russian National Research Medical University Named After Pirogov N.I., Moscow. Russian Federation
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Ibrahim D, Mashhour S. Report of a case of Cobb syndrome: multimodality imaging. BJR Case Rep 2020; 7:20200145. [PMID: 33614124 PMCID: PMC7869133 DOI: 10.1259/bjrcr.20200145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/03/2022] Open
Abstract
Cobb syndrome is a rare vascular disorder characterized by vascular skin lesions distributed in a dermatomal pattern, with corresponding muscular, osseous, paraspinal, and/or spinal vascular lesions occurring at the same body somite (metamere). We present a case of a 25-year-old man who presented with a history of right upper limb paresthesia followed by bilateral progressive upper and lower limb weakness and heaviness. Physical examination showed large cutaneous port wine stains on the right side of the chest, the nape, and along the whole right upper limb in a dermatomal distribution, with no corresponding limb hypertrophy or asymmetry. MRI and CT scan of the cervical spine showed aggressive vertebral hemangiomas involving the right side of C1 down to C4 vertebrae associated with extraosseous epidural lesion causing cervical cord compression, in addition to right paraspinal muscular low flow vascular malformations. Digital subtraction angiography of the neck vessels showed corresponding vascular blush and delayed contrast pooling in the affected regions. Cobb syndrome was diagnosed based on the dermatomal distribution of the cutaneous vascular lesions and the corresponding vertebral, epidural, and paraspinal vascular lesions occurring at the same metamere. The patient underwent a decompressive laminectomy at C2–C6 levels with removal of the epidural lesion, after which his symptoms had improved.
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Affiliation(s)
- Dalia Ibrahim
- Department of Radiology, Kasr Al Ainy Hospital, Cairo, Egypt
| | - Shady Mashhour
- Department of Radiology, Kasr Al Ainy Hospital, Cairo, Egypt
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Mekonnen B, Richardson Q, Bhisitkul JM, Diab M, Rasool N. Bilateral optic disc pits in a pediatric patient with Cobb syndrome. Am J Ophthalmol Case Rep 2020; 19:100749. [PMID: 32518855 PMCID: PMC7270543 DOI: 10.1016/j.ajoc.2020.100749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 11/01/2022] Open
Abstract
Purpose To describe a patient with Cobb Syndrome, a rare congenital disorder characterized by cutaneous and spinal arteriovenous malformations, who was found to have bilateral optic nerve pits. Observations A 15-year-old boy diagnosed with Cobb Syndrome, manifesting as a large cutaneous port-wine stain associated with an underlying left paraspinous arteriovenous malformation resulting in severe scoliosis, presented for a screening ophthalmological exam. The patient had no visual symptoms. On examination, his visual acuity was 20/20 in each eye; however, bilateral optic disc pits were discovered on biomicroscopy and confirmed by spectral-domain optical coherence tomography. Conclusion and importance The unusual finding of bilateral optic disc pits in this rare congenital neurocutaneous disorder represents the first report of ophthalmic abnormalities in association with Cobb syndrome. Patients with Cobb Syndrome may be considered for screening ophthalmological exam for the detection of subclinical optic nerve abnormalities.
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Affiliation(s)
- Bethlehem Mekonnen
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Quintin Richardson
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Jonah M Bhisitkul
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Mohammad Diab
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nailyn Rasool
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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Minagar M, Dehghan-Tezerjani M, Khan ZH. Anesthetic Considerations in Cobb Syndrome: A Case Report. A A Pract 2020; 13:137-139. [PMID: 30973350 DOI: 10.1213/xaa.0000000000001016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cutaneomeningospinal angiomatosis, popularly known as Cobb syndrome, is a rare clinical disorder predominantly presenting with a vascular skin lesion and a spinal angioma at the same dermatomal level. Several case reports and case series have reported on the surgical management of this syndrome, but we failed to find any information about its anesthetic considerations in the Medline database. Our case report describes the perioperative anesthetic management of a 46-year-old man with Cobb syndrome.
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Affiliation(s)
- Milad Minagar
- From the Department of Anesthesiology and Critical Care, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
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Li ZF, Li Q, Xu Y, Hong B, Huang QH, Liu JM. Spinal Arteriovenous Malformation Associated with Parkes Weber Syndrome: Report of Two Cases and Literature Review. World Neurosurg 2017. [DOI: 10.1016/j.wneu.2017.06.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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10
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Papalini PE, Papalini FR. Cervicothoracic cutaneomeningospinal angiomatosis in adults (Cobb's syndrome): A case report of acute quadriparesis. Surg Neurol Int 2017; 8:147. [PMID: 28791190 PMCID: PMC5525462 DOI: 10.4103/sni.sni_363_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 05/05/2017] [Indexed: 11/24/2022] Open
Abstract
Background: Cutaneomeningospinal angiomatosis or Cobb syndrome is a rare, not well understood phacomatosis that features metameric cutaneous and spinal arteriovenous malformations (AVMs). The first case was described in Boston in 1915, and since then, few more cases have been reported in the English literature. No case was found to be from Argentina. Case Description: The authors present a 16-year-old boy with acute quadriparesis and respiratory failure who was diagnosed as Cobb syndrome and treated with microsurgery alone with very good results. Conclusion: Authors believe that microsurgery, alone or combined with embolization, should be the mainstay of treatment. They also acknowledge Harvey Cushing's contribution to the description of the syndrome and propose the syndrome to be renamed as Cobb–Cushing syndrome.
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Affiliation(s)
- Pablo E Papalini
- Department of Neurosurgery, Hospital Córdoba, Córdoba, Argentina
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Huynh C, Gahtan V, Schwartz R. Endovascular stent graft exclusion of a thoracic arteriovenous malformation in a patient with Cobb syndrome. J Vasc Surg Cases 2016; 2:7-9. [PMID: 31724598 PMCID: PMC6849967 DOI: 10.1016/j.jvsc.2015.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/19/2015] [Indexed: 11/15/2022] Open
Abstract
Cobb syndrome is a rare neurocutaneous disorder characterized by spinal vascular abnormalities in association with a vascular lesion of the skin at the same metamere. Patients present after the onset of symptoms such as paraplegia, back pain, and, less commonly, fatigue due to heart failure. Available treatment options to date have included neurosurgical resection and endovascular embolization. We present a patient with Cobb syndrome with a progressively symptomatic arteriovenous malformation involving the thoracic vertebrae and left hemithorax, with extensive blood supply from the T3 to T10 intercostal arteries, and demonstrate successful endovascular thoracic stent graft placement and coil embolization.
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Affiliation(s)
- Cindy Huynh
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY
| | - Vivian Gahtan
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY
| | - Robert Schwartz
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY
- Department of Surgery, Crouse Hospital, Syracuse, NY
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12
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Abstract
Cobb syndrome is an exceedingly rare clinical condition defined by the presence of a vascular skin nevus and an angioma in the spinal canal at the same metamere. We report the case of a 14-year-old boy who presented with sudden onset paraplegia. Physical examination showed port-wine stains over buttock and thigh. Magnetic resonance (MR) angiogram of the dorso-lumbar spine revealed a large arteriovenous malformation (AVM) at D11-D12 to L2-L3 levels. These concurrent findings led to the diagnosis of Cobb’s syndrome. The patient received orally administered prednisolone therapy and underwent endovascular embolization of spinal angioma. Cobb’s syndrome is a rare disease entity and literature search revealed only a few case reports and series mentioning this condition to date. The importance lies in the recognition that cutaneous vascular lesions may clue to an associated spinal cord angioma or AVM that may lead to weakness or paralysis.
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Elkordy A, Endo T, Sato K, Sonoda Y, Takahashi A, Tominaga T. Exclusively epidural spinal metameric arteriovenous shunts: case report and literature review. Spine J 2015; 15:e15-22. [PMID: 25450654 DOI: 10.1016/j.spinee.2014.11.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/13/2014] [Accepted: 11/22/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal arteriovenous metameric syndrome (SAMS) is a subgroup of spinal arteriovenous malformations (AVMs). Most SAMS cases have intra- and extradural AVMs and suffer from hematomyelia, subarachnoid hemorrhage, or venous congestive myelopathy. PURPOSE To present a rare case of SAMS in which spinal AVMs were exclusively epidural. We reviewed previous literature and evaluated the feasibility of a treatment strategy using endovascular interventions, followed by surgical obliteration. STUDY DESIGN A case report and literature review of SAMS. METHODS We report a case of a 15-year-old boy suffering from SAMS in which epidural venous ectasia because of extradural AVMs caused spinal cord compression. RESULTS The patient was successfully treated with multiple sessions of transarterial embolization followed by open surgery. After the treatment, his neurologic deficits resolved. Postoperative angiography confirmed complete obliteration of extradural AVMs. CONCLUSIONS Although exclusively epidural spinal AVM is an uncommon type of SAMS, combined endovascular and surgical interventions can be an effective treatment for AVMs to achieve better radiologic outcomes and complete resolution of patient symptoms.
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Affiliation(s)
- Alaa Elkordy
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan; Department of Neuroendovascular Therapy, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan; Neuroendovascular Section, Department of Neurology, Tanta University, 45 El-Geish St., Tanta 31111, Egypt
| | - Toshiki Endo
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan.
| | - Kenichi Sato
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan; Department of Neuroendovascular Therapy, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan
| | - Akira Takahashi
- Department of Neuroendovascular Therapy, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai 980-8574, Japan
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Razek AAKA. Vascular neurocutaneous disorders: neurospinal and craniofacial imaging findings. Jpn J Radiol 2014; 32:519-28. [DOI: 10.1007/s11604-014-0345-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/08/2014] [Indexed: 11/29/2022]
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Gross BA, Du R. Spinal juvenile (Type III) extradural-intradural arteriovenous malformations. J Neurosurg Spine 2014; 20:452-8. [DOI: 10.3171/2014.1.spine13498] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Owing to their rarity, demographics, natural history, and treatment, results for spinal juvenile (Type III) extradural-intradural arteriovenous malformations (AVMs) are frequently only provided in case report format.
Methods
A pooled analysis was performed utilizing the PubMed database through April 2013. Individualized patient data were extracted to elucidate demographics, hemorrhage risk, and treatment result information.
Results
Twenty-nine studies describing 51 patients were included. The mean age at presentation was 15.0 ± 10.5 years with a slight male predilection (63%, 1.7:1 sex ratio). Presentation modality included progressive deficits in 35%, hemorrhage in 31%, acute deficits not attributed to hemorrhage in 22%, and asymptomatic/incidental in 12% of patients. The annual hemorrhage rate was 2.1%; statistically significant risk factors for hemorrhage included presentation age (HR 0.39 [95% CI 0.18–0.87]) and associated aneurysms (HR 8.74 [95% CI 1.76–43.31]). Seventy-seven percent of patients underwent treatment; after a mean follow-up of 2.6 ± 3.2 years, 73% were improved, 10% were the same, and 17% were worse neurologically. Of 25 cases with described angiographic results, 8 lesions were obliterated (32%). Of these 25 patients, 8 had AVMs with associated aneurysms, and the aneurysm was obliterated in all 8 patients. Over the course of 57.9 patient-years of follow-up, including 55.3 patient-years for partially treated AVMs, no hemorrhages were described, reflecting a trend toward protection from hemorrhage after treatment (p = 0.12, likelihood ratio test).
Conclusions
Spinal juvenile (Type III) extradural-intradural AVMs commonly present symptomatically. Associated arterial aneurysms increase their hemorrhage risk, and protection from hemorrhage may be achieved from partial obliteration of these lesions, particularly if targeted toward associated aneurysms.
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Matsui Y, Mineharu Y, Satow T, Takebe N, Takeuchi E, Saiki M. Coexistence of multiple cavernous angiomas in the spinal cord and skin: a unique case of Cobb syndrome. J Neurosurg Spine 2014; 20:142-7. [DOI: 10.3171/2013.11.spine13419] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cobb syndrome is a rare, noninherited, neurocutaneous disease characterized by vascular abnormality of the spinal cord and is associated with vascular lesions in the skin at the same metamere. The majority of spinal vascular lesions are arteriovenous malformations, and skin lesions are mostly port-wine angiomas. The authors report the first case of multiple intramedullary cavernous angiomas (CAs) accompanied by skin CAs within the same metamere. A 42-year-old man presented with an acute onset of gait disturbance, low-back pain, and urinary incontinence. Magnetic resonance imaging of the thoracolumbar spine showed homogeneously enhanced lesions on a contrast-enhanced T1-weighted image and a hypointense area on a T2*-weighted image surrounding this enhanced lesion, between the T-12 and S-1 levels. Purple protruding skin lesions were detected on the left side of his gluteal region. The patient received a laminectomy followed by evacuation of a hematoma and partial removal of the tumor, which completely resolved his neurological symptoms. Pathological examinations showed that the spinal and skin lesions were CAs, suggesting that these vascular lesions developed congenitally. Cavernous angiomas associated with Cobb syndrome present with multiple lesions spanning more than 3 vertebral levels, making it difficult to completely resect these tumors. Although Cobb syndrome is an uncommon disease entity, it should be considered if a patient manifesting with neurological deficits has skin vascular lesions, including CAs.
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Affiliation(s)
| | | | | | | | - Eiji Takeuchi
- 2Diagnostic Pathology, Shiga Medical Center for Adults, Shiga, Japan
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Madhugiri VS, Ambekar S, Roopesh Kumar VR, Sasidharan GM, Nanda A. Spinal aneurysms: clinicoradiological features and management paradigms. J Neurosurg Spine 2013; 19:34-48. [DOI: 10.3171/2013.3.spine121026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Object
Spinal aneurysms (SAs) are rare lesions. The clinicoradiological features and the exact degree of their association with comorbid conditions such as arteriovenous malformations (AVMs) and coarctation of the aorta have not been definitively described. The ideal management paradigm has not been established. The authors reviewed literature to determine the clinical patterns of presentation, management, and outcome of spinal aneurysms.
Methods
A systematic review of literature was performed using 23 separate strings. A total of 10,190 papers were screened to identify 87 papers that met the inclusion criteria. A total of 123 SAs could be included for analysis.
Results
The mean age of patients at presentation was 38 years; 10% of patients were aged less than 10 years and nearly 50% were greater than 38 years. Spinal aneurysms can be divided into 2 groups: those associated with AVMs (SA-AVMs, or Type 1 SAs) and those with isolated aneurysms (iSAs, or Type 2 SAs). Patients with Type 2 SAs were older and more likely to present with bleeding than those with Type 1 SAs. The acute syndromes can be divided into 3 groups of patients: those with spinal syndrome, those with cranial/craniospinal syndrome, and those with nonspecific presentation. Overall, 32.6% presented with angiography-negative cranial subarachnoid hemorrhage (SAH). Presentation with evidence of cord dysfunction (myelopathy/weakness/sensory loss/bladder involvement) correlated with poor outcome, as did presentation with hemorrhage and association with other comorbid conditions. Surgery and endovascular therapy both led to comparable rates of complete aneurysm obliteration for Type 2 SAs, whereas for the AVM-associated Type 1 SAs, surgery led to better rates of lesion obliteration. The authors propose a classification scheme for spinal aneurysms based on whether the lesion is solitary or is associated with a coexistent spinal AVM; this would also imply that the ideal therapy for the aneurysm would differ based on this association.
Conclusions
The clinical and radiological patterns that influence outcome are distinct for Type 1 and Type 2 SAs. The ideal treatment for Type 1 SAs appears to be excision, whereas surgery and endovascular therapy were equally effective for Type 2 SAs.
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Affiliation(s)
- Venkatesh S. Madhugiri
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - Sudheer Ambekar
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
| | - V. R. Roopesh Kumar
- 2Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Gopalakrishnan M. Sasidharan
- 2Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Anil Nanda
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
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19
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Linfante I, Tari Capone F, Dabus G, Gonzalez-Arias S, Lau PE, Samaniego EA. Spinal arteriovenous malformation associated with spinal metameric syndrome: a treatable cause of long-term paraplegia? J Neurosurg Spine 2012; 16:408-13. [PMID: 22225485 DOI: 10.3171/2011.12.spine11636] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cutaneomeningospinal angiomatosis, or Cobb syndrome, is a rare metameric developmental disorder presenting as an extradural-intradural vascular malformation that involves bone, muscle, skin, spinal cord, and nerve roots. A 14-year-old girl with a red nevus involving the T6-9 dermatomes on the left side of her back presented with a 5-year history of bowel and bladder incontinence, paraplegia, and lower-extremity sensory loss. Magnetic resonance imaging demonstrated a hemangioma in the T-8 and T-9 vertebral bodies and a spinal cord AVM nidus extending from T-6 to T-9. The AVM was successfully embolized and the patient regained lower-extremity strength, ambulation, and normal sphincter functions after 5 years of having been wheelchair bound. The authors report the restoration of ambulation after endovascular embolization of a large spinal AVM in a patient with long-standing paraplegia due to Cobb syndrome.
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Affiliation(s)
- Italo Linfante
- Department of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA.
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