Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Delayed Cerebral Ischemia after Embolization in Ruptured Spinal Arteriovenous Fistula with Subarachnoid Hemorrhage : A Case Report

  • Achmad Firdaus Sani (Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga) ;
  • Dedy Kurniawan (Department of Neurology, Faculty of Medicine, Universitas Airlangga) ;
  • Muhammad Hamdan (Department of Neurology, Faculty of Medicine, Universitas Airlangga) ;
  • Jovian Philip Swatan (Department of Neurology, Faculty of Medicine, Universitas Airlangga)
  • Received : 2022.06.10
  • Accepted : 2022.09.22
  • Published : 2023.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Delayed cerebral ischemia (DCI) remains a devastating complication in subarachnoid hemorrhage (SAH), however, there were no present reports that is associated with a ruptured spinal arteriovenous fistula (sAVF). We would like to present a rare case of DCI following embolization of a ruptured perimedullary sAVF. Initially, the patient clinical symptoms mimic a SAH caused by a ruptured intracranial aneurysm. Further evaluation revealed that the SAH was caused by a ruptured perimedullary sAVF and the patient's condition improved following the embolization procedure. Three days later, the patient developed an acute left-sided facial and motor weakness, which persisted until the patient was discharged on the day-15 onset. A magnetic resonance imaging and angiography is performed 1.5 years after discharge and revealed no signs of cerebral infarction and hemorrhage. In this paper, we reported DCI after embolization in a ruptured sAVF with SAH, supported by evidence from the current literature. We would like to also stress the importance of complete spinal and cerebral vessel imaging to reveal the underlying abnormalities and determine the most appropriate intervention.

Keywords

References

  1. Ayata C, Lauritzen M : Spreading depression, spreading depolarizations, and the cerebral vasculature. Physiol Rev 95 : 953-993, 2015 https://doi.org/10.1152/physrev.00027.2014
  2. Dodd WS, Laurent D, Dumont AS, Hasan DM, Jabbour PM, Starke RM, et al. : Pathophysiology of delayed cerebral ischemia after subarachnoid hemorrhage: a review. J Am Heart Assoc 10 : e021845,
  3. Francoeur CL, Mayer SA : Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care 20 : 277, 2016
  4. Goursaud S, Martinez de Lizarrondo S, Grolleau F, Chagnot A, Agin V, Maubert E, et al. : Delayed cerebral ischemia after subarachnoid hemorrhage: is there a relevant experimental model? A systematic review of preclinical literature. Front Cardiovasc Med 8 : 752769,
  5. Ikram A, Javaid MA, Ortega-Gutierrez S, Selim M, Kelangi S, Anwar SMH, et al. : Delayed cerebral ischemia after subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 30 : 106064,
  6. Koch MJ, Stapleton CJ, Agarwalla PK, Torok C, Shin JH, Coumans JV, et al. : Open and endovascular treatment of spinal dural arteriovenous fistulas: a 10-year experience. J Neurosurg Spine 26 : 519-523, 2017 https://doi.org/10.3171/2016.9.SPINE16394
  7. Krings T, Geibprasert S : Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 30 : 639-648, 2009 https://doi.org/10.3174/ajnr.A1485
  8. Murai S, Hiramatsu M, Suzuki E, Ishibashi R, Takai H, Miyazaki Y, et al. : Trends in incidence of intracranial and spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan. Stroke 52 : 1455-1459, 2021 https://doi.org/10.1161/STROKEAHA.120.032052
  9. Neifert SN, Chapman EK, Martini ML, Shuman WH, Schupper AJ, Oermann EK, et al. : Aneurysmal subarachnoid hemorrhage: the last decade. Transl Stroke Res 12 : 428-446,
  10. Qureshi AI, Luft AR, Sharma M, Guterman LR, Hopkins LN : Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: part II--clinical aspects and recommendations. Neurosurgery 46 : 1360-1375, 2000 https://doi.org/10.1097/00006123-200006000-00014
  11. Sarrafzadeh AS, Vajkoczy P, Bijlenga P, Schaller K : Monitoring in neurointensive care - the challenge to detect delayed cerebral ischemia in high-grade aneurysmal SAH. Front Neurol 5 : 134, 2014
  12. Takai K : Spinal arteriovenous shunts: angioarchitecture and historical changes in classification. Neurol Med Chir (Tokyo) 57 : 356-365, 2017 https://doi.org/10.2176/nmc.ra.2016-0316
  13. van der Kleij LA, De Vis JB, Olivot JM, Calviere L, Cognard C, Zuithoff NP, et al. : Magnetic resonance imaging and cerebral ischemia after aneurysmal subarachnoid hemorrhage: a systematic review and metaanalysis. Stroke 48 : 239-245, 2017 https://doi.org/10.1161/STROKEAHA.116.011707
  14. Vergouwen MD, Vermeulen M, van Gijn J, Rinkel GJ, Wijdicks EF, Muizelaar JP, et al. : Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke 41 : 2391-2395, 2010 https://doi.org/10.1161/STROKEAHA.110.589275
  15. Zhao J, Esemen Y, Rane N, Nair R : Intracranial subarachnoid haemorrhage caused by cervical spinal dural arteriovenous fistulas: case report. Front Neurol 12 : 685332, 2021