1273 - Spinal Arteriovenous Malformation: A Case Report of a Rare and Understudied Cause of Non-traumatic Spinal Cord Injuries

Case Diagnosis:
Spinal arteriovenous malformations (AVMs) are a rare and understudied cause of non-traumatic spinal cord injuries, with approximately 300 cases requiring inpatient treatment each year. These lesions pose significant challenges for treatment due to their complex anatomy and physiology, which can lead to neurological damage through mass effect, venous obstruction, and ischemia.

Case Description: A 28-year-old female with a known history of spinal AVM presented with a chief concern of severe back pain and right-sided hemiparesis. The patient was initially evaluated two years prior, during pregnancy, for right-sided numbness, decreased dexterity, and difficulty swallowing. At that time, a diagnostic work-up revealed a high cervical spine AVM with arterial supply from both the anterior spinal artery (ASA) and posterior spinal artery (PSA). She was managed conservatively with dexamethasone and outpatient therapy, leading to the resolution of her symptoms. During her current presentation, she experienced progressive weakness that ultimately resulted in quadriplegia and respiratory failure, necessitating a tracheostomy. Due to the high risk of complications associated with surgical resection or embolization, the patient ultimately elected for conservative management and was discharged for acute inpatient rehabilitation.

Discussions: General treatment options for spinal AVMs include surgical occlusion, surgical decompression, or endovascular embolization. In our patient's case, intervention posed a high degree of risk due to her dual arterial supply as well as her significant cord edema and hemorrhage. Both endovascular embolization and decompression laminectomy were considered as possible interventions but were determined to have uncertain clinical benefit. Ultimately, the patient opted for conservative management.

Conclusions:
We present the case of a 28-year-old female with a high cervical spine AVM receiving dual arterial supply from ASA and PSA, which ultimately led to respiratory failure and quadriplegia. This case highlights the challenges in the clinical presentation, progression, and diagnosis of spinal AVMs while underscoring the dilemma associated with making management decisions.