An Official publication of The Asian Congress of Neurological Surgeons (AsianCNS)

Search Article
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Advertise Subscribe Contacts Login  Facebook Tweeter
  Users Online: 6050 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Year : 2021  |  Volume : 16  |  Issue : 3  |  Page : 638-644

Remote intramedullary hemorrhage in the thoracic spinal cord secondary to a perimedullary arteriovenous fistula of the distal end of conus medullaris mimicking filum terminale arteriovenous fistula

1 Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand
2 Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand
3 Department of Radiology, Bumrungrad International Hospital, Bangkok, Thailand
4 Department of Radiology, Division of Interventional Neuroradiology, Ramathibodi Hospital Medical School, Mahidol University, Bangkok, Thailand

Correspondence Address:
Dr. Prasert Iampreechakul
312 Rachawithi Road, Khwaeng Thung Phaya Thai, Bangkok 10400
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajns.ajns_185_21

Rights and Permissions

Perimedullary arteriovenous fistulas (PMAVFs) of the conus medullaris are rare and usually manifest with progressive myelopathy secondary to venous congestion resulting from retrograde arterialization of the draining vein into the spinal cord. We present a rare case of conus PMAVF presenting with remote intramedullary spinal cord hemorrhage in the thoracic cord. A 37-year-old woman was transferred to our institute due to sudden severe pain in the left lower leg and weakness of the lower extremities following progressive paresthesia of the lower extremities. Magnetic resonance imaging of the thoracic and lumbosacral spine revealed spinal cord congestion extending from the conus medullaris to the level of T6 with intramedullary hemorrhage at the level of T8–9 on the left side of the spinal cord. There were abnormal serpiginous intradural flow voids along the anterior surface of the spinal cord extending from the level of L2 to the lower cervical with venous varix at the level of T8–9, probably being the source of hemorrhage. Spinal angiography confirmed conus PMAVF at the distal end of the conus medullaris supplied by the sulco-commissural artery arising from the enlarged anterior spinal artery originating from the left T11 intercostal artery with cranial drainage through the dilated anterior spinal vein into the tortuous perimedullary veins up to the lower cervical level. The patient underwent successful endovascular treatment with N-butyl cyanoacrylate and had gradually improved until being ability to walk independently without residual pain of the left lower leg. We speculated that an increased venous flow into a varix may be considered an important risk factor of hemorrhage.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded36    
    Comments [Add]    

Recommend this journal