Skip to main content

Advertisement

SpringerLink
Log in

Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Objective

In patients with non-traumatic subarachnoid hemorrhage (SAH) and no evidence for a cerebral aneurysm on angiography, a frequent cause of the hemorrhage is perimesencephalic hemorrhage or other cerebral vascular pathology. In some patients no cause is found. The exact incidence of a spinal vascular malformation (SVM) as the origin for the SAH is not known. We assessed the occurrence of SVM in angiogram-negative, non-perimesencephalic subarachnoid hemorrhage (NPSAH).

Methods

47 patients (from a consecutive cohort of 632) were identified with an angiogramnegative, non-perimesencephalic subarachnoid hemorrhage and 42 of these were analyzed by performing MR-imaging of the complete spinal neuraxis with additional spinal angiography on indication.

Results

In four patients a spinal vascular malformation was identified as the cause of the SAH, indicating an incidence of 9 % of SVM in NPSAH, and an incidence of 1 % of SVM in all patients with SAH.

Interpretation

Systematic analysis of angiogram-negative, non-perimesencephalic subarachnoid hemorrhage by MR imaging of the complete spinal neuraxis yields a higher incidence of SVM than previously documented. We recommend MR imaging of the complete spinal neuraxis in patients with a non-perimesencephalic subarachnoid hemorrhage in whom no cause for the hemorrhage has been found.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Acciarri N, Padovani R, Pozzati E, Gaist G, Manetto V (1992) Spinal cavernous angioma: a rare cause of subarachnoid hemorrhage. Surg Neurol 37:453–456

    Article  PubMed  CAS  Google Scholar 

  2. Aviv RI, Shad A, Tomlinson G, Niemann D, Teddy PJ, Molyneux AJ, Byrne JV (2004) Cervical dural arteriovenous fistulae manifesting as subarachnoid hemorrhage: report of two cases and literature review. AJNR Am J Neuroradiol 25:854–858

    PubMed  Google Scholar 

  3. Beguelin C, Seiler R (1983) Subarachnoid hemorrhage with normal cerebral panangiography. Neurosurgery 13:409–411

    Article  PubMed  CAS  Google Scholar 

  4. Bruni P, Massari A, Greco R, Hernandez R, Oddi G, Chiappetta F (1994) Subarachnoid hemorrhage from cavernous angioma of the cauda equina: case report. Surg Neurol 41:226–229

    Article  PubMed  CAS  Google Scholar 

  5. Caglar YS, Torun F, Pait G, Bagdatoglu C, Sancak T (2005) Ruptured aneurysm of the posterior spinal artery of the conus medullaris. J Clin Neurosci 12:603–605

    Article  PubMed  Google Scholar 

  6. Canhao P, Ferro JM, Pinto AN, Melo TP, Campos JG (1995) Perimesencephalic and nonperimesencephalic subarachnoid haemorrhages with negative angiograms. Acta Neurochir (Wien) 132:14–19

    Article  CAS  Google Scholar 

  7. Casado NI, Sancho RJ, Martin GR, Cerda M, Soler J (1987) Recurrent subarachnoid haemorrhage due to spinal haemangioma. J Neurol Neurosurg Psychiatry 50:1722–1723

    Article  Google Scholar 

  8. Cioffi F, Pasqualin A, Cavazzani P, Da PR (1989) Subarachnoid haemorrhage of unknown origin: clinical and tomographical aspects. Acta Neurochir (Wien) 97:31–39

    Article  CAS  Google Scholar 

  9. Congia S, Carta S, Coraddu M (1994) Subarachnoid hemorrhage of unknown origin. A 44 cases study. Acta Neurol (Napoli) 16:177–183

    CAS  Google Scholar 

  10. Do HM, Jensen ME, Cloft HJ, Kallmes DF, Dion JE (1999) Dural arteriovenous fistula of the cervical spine presenting with subarachnoid hemorrhage. AJNR Am J Neuroradiol 20:348–350

    PubMed  CAS  Google Scholar 

  11. Duong H, Melancon D, Tampieri D, Ethier R (1996) The negative angiogram in subarachnoid haemorrhage. Neuroradiology 38:15–19

    Article  PubMed  CAS  Google Scholar 

  12. Flaherty ML, Haverbusch M, Kissela B, Kleindorfer D, Schneider A, Sekar P, Moomaw CJ, Sauerbeck L, Broderick JP, Woo D (2005) Perimesencephalic Subarachnoid Hemorrhage: Incidence, Risk Factors, and Outcome. J Stroke Cerebrovasc Dis 14:267–271

    Article  PubMed  Google Scholar 

  13. Giombini S, Bruzzone MG, Pluchino F (1988) Subarachnoid hemorrhage of unexplained cause. Neurosurgery 22:313–316

    Article  PubMed  CAS  Google Scholar 

  14. Hashimoto H, Iida J, Shin Y, Hironaka Y, Sakaki T (2000) Spinal dural arteriovenous fistula with perimesencephalic subarachnoid haemorrhage. J Clin Neurosci 7:64–66

    Article  PubMed  CAS  Google Scholar 

  15. Heimberger K, Schnaberth G, Koos W, Pendl G, Auff E (1982) Spinal cavernous haemangioma (intradural-extramedullary) underlying repeated subarachnoid haemorrhage. J Neurol 226:289–293

    Article  PubMed  CAS  Google Scholar 

  16. Ishihara H, Kato S, Akimura T, Suehiro E, Oku T, Suzuki M (2007) Angiogramnegative subarachnoid hemorrhage in the era of three dimensional rotational angiography. J Clin Neurosci 14:252–255

    Article  PubMed  Google Scholar 

  17. Kai Y, Hamada J, Morioka M, Yano S, Mizuno T, Kuratsu J (2005) Arteriovenous fistulas at the cervicomedullary junction presenting with subarachnoid hemorrhage: six case reports with special reference to the angiographic pattern of venous drainage. AJNR Am J Neuroradiol 26:1949–1954

    PubMed  Google Scholar 

  18. Kassell NF, Adams HP Jr, Torner JC, Sahs AL (1981) Influence of timing of admission after aneurysmal subarachnoid hemorrhage on overall outcome. Report of the cooperative aneurysm study. Stroke 12:620–623

    PubMed  CAS  Google Scholar 

  19. Kawamura S, Yasui N (1990) Clinical and long-term follow-up study in patients with spontaneous subarachnoid haemorrhage of unknown aetiology. Acta Neurochir (Wien) 106:110–114

    Article  CAS  Google Scholar 

  20. Kim CH, Kim HJ (2002) Cervical subarachnoid floating cavernous malformation presenting with recurrent subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 72:668

    Article  PubMed  CAS  Google Scholar 

  21. Koch C (2006) Spinal dural arteriovenous fistula. Curr Opin Neurol 19:69–75

    Article  PubMed  Google Scholar 

  22. Koch C, Gottschalk S, Giese A (2004) Dural arteriovenous fistula of the lumbar spine presenting with subarachnoid hemorrhage. Case report and review of the literature. J Neurosurg 100:385–391

    PubMed  Google Scholar 

  23. Little AS, Garrett M, Germain R, Farhataziz N, Albuquerque FC, McDougall CG, Zabramski JM, Nakaji P, Spetzler RF (2007) Evaluation of patients with spontaneous subarachnoid hemorrhage and negative angiography. Neurosurgery 61:1139–1150

    PubMed  Google Scholar 

  24. Logue V (1979) Angiomas of the spinal cord: review of the pathogenesis, clinical features, and results of surgery. J Neurol Neurosurg Psychiatry 42:1–11

    Article  PubMed  CAS  Google Scholar 

  25. Marconi F, Parenti G, Giorgetti V, Puglioli M (1995) Spinal cavernous angioma producing subarachnoid hemorrhage. Case report. J Neurosurg Sci 39:75–80

    PubMed  CAS  Google Scholar 

  26. Mocco J, Laufer I, Mack WJ, Winfree CJ, Libien J, Connolly ES Jr (2005) An extramedullary foramen magnum cavernous malformation presenting with acute subarachnoid hemorrhage: case report and literature review. Neurosurgery 56:E410

    Article  PubMed  CAS  Google Scholar 

  27. Mori K, Ishii H, Tomita Y, Nakajima K, Morimoto K, Maeda M (1991) Intradural- extramedullary spinal cavernous angioma – case report. Neurol Med Chir (Tokyo) 31:593–596

    Article  CAS  Google Scholar 

  28. Morimoto T, Yoshida S, Basugi N (1992) Dural arteriovenous malformation in the cervical spine presenting with subarachnoid hemorrhage: case report. Neurosurgery 31:118–120

    Article  PubMed  CAS  Google Scholar 

  29. Mourier KL, Gobin YP, George B, Lot G, Merland JJ (1993) Intradural perimedullary arteriovenous fistulae: results of surgical and endovascular treatment in a series of 35 cases. Neurosurgery 32:885–891

    Article  PubMed  CAS  Google Scholar 

  30. Oder W, Kollegger H, Zeiler K, Dal- Bianco P, Wessely P, Deecke L (1991) Subarachnoid hemorrhage of unknown etiology: early prognostic factors for long-term functional capacity. J Neurosurg 74:601–605

    PubMed  CAS  Google Scholar 

  31. Ohmori Y, Hamada J, Morioka M, Yoshida A (2005) Spinal aneurysm arising from the feeding pedicle of a thoracic perimedullary arteriovenous fistula: case report. Surg Neurol 64:468–470

    Article  PubMed  Google Scholar 

  32. Rinkel GJ, van GJ, Wijdicks EF (1993) Subarachnoid hemorrhage without detectable aneurysm. A review of the causes. Stroke 24:1403–1409

    PubMed  CAS  Google Scholar 

  33. Rodesch G, Lasjaunias P (2003) Spinal cord arteriovenous shunts: from imaging to management. Eur J Radiol 46:221–232

    Article  PubMed  CAS  Google Scholar 

  34. Ronkainen A, Hernesniemi J (1992) Subarachnoid haemorrhage of unknown aetiology. Acta Neurochir (Wien) 119:29–34

    Article  CAS  Google Scholar 

  35. Rosenblum B, Oldfield EH, Doppman JL, Di CG (1987) Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM’s in 81 patients. J Neurosurg 67:795–802

    PubMed  CAS  Google Scholar 

  36. Ruelle A, Lasio G, Boccardo M, Gottlieb A, Severi P (1985) Long-term prognosis of subarachnoid hemorrhages of unknown etiology. J Neurol 232:277–279

    Article  PubMed  CAS  Google Scholar 

  37. Schaller C, Raueiser B, Rohde V, Hassler W (1996) Cerebral vasospasm after subarachnoid haemorrhage of unknown aetiology: a clinical and transcranial Doppler study. Acta Neurochir (Wien) 138:560–568

    Article  CAS  Google Scholar 

  38. Schwartz TH, Solomon RA (1996) Perimesencephalic nonaneurysmal subarachnoid hemorrhage: review of the literature. Neurosurgery 39:433–440

    Article  PubMed  CAS  Google Scholar 

  39. Shephard RH (1992) Spinal arteriovenous malformations and subarachnoid haemorrhage. Br J Neurosurg 6:5–12

    Article  PubMed  CAS  Google Scholar 

  40. Spallone A, Ferrante L, Palatinsky E, Santoro A, Acqui M (1986) Subarachnoid haemorrhage of unknown origin. Acta Neurochir (Wien) 80:12–17

    Article  CAS  Google Scholar 

  41. Suzuki S, Kayama T, Sakurai Y, Ogawa A, Suzuki J (1987) Subarachnoid hemorrhage of unknown cause. Neurosurgery 21:310–313

    Article  PubMed  CAS  Google Scholar 

  42. Ueda S, Saito A, Inomori S, Kim I (1987) Cavernous angioma of the cauda equina producing subarachnoid hemorrhage. Case report. J Neurosurg 66:134–136

    Article  PubMed  CAS  Google Scholar 

  43. Van CF, Plets C, Goffin J, Velghe L (1993) Nonaneurysmal subarachnoid hemorrhage: prevalence of perimesencephalic hemorrhage in a consecutive series. Surg Neurol 39:320–323

    Article  Google Scholar 

  44. van SH, de Witt Hamer PC (2003) Spinal AV malformation. Lancet 361:1766

  45. Vates GE, Quinones-Hinojosa A, Halbach VV, Lawton MT (2001) Conus perimedullary arteriovenous fistula with intracranial drainage: case report. Neurosurgery 49:457–461

    Article  PubMed  CAS  Google Scholar 

  46. Velghe LE, De WP (1983) Cryptogenic spontaneous subarachnoid haemorrhage. Clin Neurol Neurosurg 85:139–144

    Article  PubMed  CAS  Google Scholar 

  47. Walton JN (1956) Subarachnoid hemorrhage. E. S. Livingstone, Edinburgh

  48. Willinsky R, terBrugge K, Lasjaunias P, Montanera W (1990) The variable presentations of craniocervical and cervical dural arteriovenous malformations. Surg Neurol 34:118–123

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, University of Amsterdam, Room H6-150, 22660, 1100 DD, Amsterdam, The Netherlands

    M. R. Germans M.D., F. A. Pennings M.D., Ph.D. & W. P. Vandertop M.D., Ph.D.

  2. Dept. of Radiology, Academic Medical Center, Amsterdam, The Netherlands

    M. E. S. Sprengers M.D.

Authors
  1. M. R. Germans M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. A. Pennings M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. E. S. Sprengers M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. P. Vandertop M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. R. Germans M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Germans, M.R., Pennings, F.A., Sprengers, M.E.S. et al. Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage. J Neurol 255, 1910–1915 (2008). https://doi.org/10.1007/s00415-009-0021-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-009-0021-4

Key words

Search

Navigation