Spontaneous Regression Of A Spinal Extradural Arterio-venous Fistula After Delivery By Cesarean Section.
Kinoshita, M., Asai, A., Komeda, S., Yoshimura, K., Takeda, J., Uesaka, T., Yamanouchi, Y., Kanzaki, H., & Kawamoto, K. (2009). spontaneous regression of a spinal extradural arterio-venous fistula after delivery by cesarean section. Neurologia medico-chirurgica, 49(7), 313–315. https://doi.org/10.2176/nmc.49.313
View Original Source →Abstract
A 23-year-old Japanese woman presented with a newly developed spinal extradural arteriovenous fistula (AVF) during pregnancy. She had been followed up for a suspected spinal cavernous angioma and became unable to walk during the 29th week of her pregnancy. Magnetic resonance (MR) imaging showed a spinal extradural AVF at the T3 to T4 levels compressing the spinal cord. After delivery by cesarean section, her neurological symptoms gradually began to resolve, and she was able to resume walking without assistance. MR imaging confirmed spontaneous regression of the AVF. This case suggests that exacerbated neurological symptoms and AVF growth triggered by pregnancy can improve after delivery without interventional treatment. Careful follow up of neurological findings is required to prevent unnecessary interventional procedures in pregnant women with spinal AVF.
Case Details
Disease Location
Spinal cord
Personal Characteristics
23 years old japanese woman, 33 weeks of pregnancy
Clinical Characteristics
Intramedulary spinal tumor since the age of 10 years. Became unable to walk during pregnancy. Hypointense mass lesion at the dorsal surface of the spinal cord just caudal to the spinal tumor located at t2 - t3. Extradural arterio-venous fistula diagnosed.
Remission Characteristics
Neurological symptoms gradually improved after delivery. Avf spontaneously regressed. Six months after delivery, her neurological symptoms abated and she was able to walk without assistance
Treatment & Mechanisms
Proposed Remission Mechanisms
Pregnancy was imporightant in the development and subsequent regression of her spinal extradural avf. Sudden post-partum changes in the circulatory system (decreases in central venous pressure and total blood volume). Changes in the concentration of circulating estrogen and progesterone may be key factors.
Clinical Treatment
C-section