MRI Findings
There was focal expansion of the spinal cord at D12/L1 vertebral level (pic 1). T2
weighted images revealed a heterogenous hypointense lesion at this level (pic 2). It
appeared isointense on T1WI. These findings were consistent with acute hemorrhage
(deoxyhaemoglobin). No enhancement was noted after intravenous administration of
Gadolinium-DTPA.
Diagnosis :
Vascular malformation of the spinal cord.
Brief Discussion :
Vascular malformations of the spine and spinal cord are uncommon lesions accounting for
3-11% of spinal space occupying lesions. Most are arterio-venous malformations (AVM's) or
arterio-venous fistulae.Cavernous angiomas and capillary telegictasias are less common.
Venous angiomas are rare. Pathologically, AVM's have a true nidus of pathological vessels
interposed between enlarged feeding arteries and draining veins. AVM's are of four types:
Type I : Commonest, is a dural AVF found in the dorsal aspect of the lower thoracic cord
and conus medullaris, typically affects men between their fifth and eighth decades.
Type II : AVMs are intramedullary, located dorsally in the cervico-medullary region,
mostly occuring in younger men.
Type III : Juvenile AVMs are intra medullary, and often have extra medullary / extraspinal
extension.
Type IV : are intra dural / extra medullary AVFs and usually lie anterior to the spinal
cord near the conus medullaris.
The commonest clinical presentations are paresis, sensory changes, bowel/ bladder
dysfunction, and impotence. Haemorrhage is seen in approximately 50% of cases.
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