動静脈奇形による頚髄硬膜外血腫の2症例

抄録

  Reports on the etiology of cervical spinal extradural hematoma secondary to epidural arteriovenous malformation (AVM) are comparatively few. We report here the clinical course and treatment outcome in two such cases.

  Case 1 : 54-year-old man visited an emergency outpatient clinic because of sudden-onset pain around the right scapula and numbness of the right arm with no apparent cause. Electrocardiography revealed an abnormal wave, necessitating urgent cardiovascular examination. No obvious coronary artery abnormality was detected, and acute coronary syndrome seemed doubtful. The next morning, the patient had complete paralysis of the right arm and both legs, and paresis of the left arm. Magnetic resonance imaging (MRI) was not possible because of a previous ophthalmologic surgery. Cervical spinal computed tomography (CT) revealed an epidural hematoma at C3-C7. C3-C6 laminectomy was emergently performed to remove the hematoma and decompress the spinal cord within 24 h after the first appearance of the disease. Histopathological analyses suggested that an abnormal blood vessel in the surrounding net was responsible for the epidural hematoma. The pathological diagnosis was epidural AVM. No obvious abnormalities were observed on postoperative conventional cerebral or cervical angiography. The patient’s neurological symptoms almost completely resolved, and he returned to work.

  Case 2 : A 41-year-old man was awakened by sudden chest and back pain. The pain in the cervical region steadily worsened, and motor paralysis in both legs progressed. When he experienced numbness below the navel and was unable to move, he was transported by ambulance to the hospital. No obvious paralysis was found in the arms, but he complained of bilateral pain in the C5 region. The anal sphincter and bulbocavernous reflex were absent. A cervical spinal epidural hematoma was identified on cervical CT and was confirmed to involve C3-C7 on MRI. No abnormal blood vessels were detected on three-dimensional CT angiography. C3-C6 laminectomy and partial C7 laminectomy were emergently performed, and the hematoma was removed within approximately 6 h after presentation. Histopathological examination revealed the same diagnosis as in Case 1. The patient in Case 2 was able to return to work.

  Emergency surgery is frequently required in patients with exacerbated neurological symptoms due to acute spinal epidural hematoma. Physicians should be cognizant of the possibility of vascular malformation such as AVM, despite its relatively low incidence, in such cases.