Spinal epidural vascular malformation presenting in association with a spontaneously resolved acute epidural hematoma

Case report

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✓ A 16-year-old boy developed acute neck pain and severe quadriparesis after mild rotatory movement of his neck. Magnetic resonance imaging revealed a cervical epidural hematoma that resolved spontaneously within a few days. Vertebral angiography demonstrated a small vascular malformation in the upper cervical epidural space. The vascular mass on the dural surface was totally resected and confirmed to be an arteriovenous malformation. This case represents the importance of including routine angiography in designing therapeutic strategy for cases of spinal epidural hematoma with spontaneous resolution.

Article Information

Address reprint requests to: Yasushi Miyagi, M.D., Ph.D., Department of Neurosurgery, Kaizuka Hospital, 7–7–27 Hakozaki, Higashi-Ku, Fukuoka 812, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Chronological series of sagittal T1-weighted MR images (TR 550 msec, TE 15 msec) showing an epidural hematoma located posterior to the spinal cord and extending from C-2 to C-6. Images were obtained at onset of symptoms (A), the next day (B), and 2 weeks later (C).

  • View in gallery

    Left vertebral angiogram (lateral view of the arterial phase) revealing a small vascular malformation in the dorsal epidural space between the arches of C-1 and C-2 (arrow).

  • View in gallery

    Photomicrograph of the specimen obtained at surgery showing the accumulation of small vessels, some of which involve the tunica media. H & E, original magnification × 80.

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