Acute Subarachnoid Hemorrhage as a Result of Ruptured C1-C2 Cervical Spinal Arteriovenous Malformation: A Unique Case Report
Solomon Nittala1, Oscar Mendoza2, Juliana Cazzaniga3
1Larkin Community Hospital Palm Springs Campus, 2Neurology, Design Neuroscience Center, 3Florida International University Herbert Wertheim College of Medicine
Background:
Subarachnoid hemorrhage (SAH) is a life-threatening medical emergency characterized by the sudden extravasation of blood into the subarachnoid space surrounding the brain. While the most common cause of SAH is the rupture of an intracranial aneurysm, an array of vascular abnormalities can give rise to this devastating condition. Among these is cervical arteriovenous malformation (AVM), a rare vascular anomaly involving the abnormal connection of arteries and veins within the cervical spinal cord. The rupture of a cervical AVM leading to SAH is an exceedingly uncommon event, making it a challenging diagnostic and therapeutic dilemma for clinicians. While cerebral AVMs have been more extensively studied, cervical AVMs remain relatively enigmatic, often presenting with a unique clinical and radiological profile. The present case sheds light on a particularly intriguing and instructive case, underscoring the importance of early diagnosis and a collaborative medical-radiological-surgical approach to optimize outcomes in such rare vascular lesions. Furthermore, it underscores the need for increased awareness among healthcare professionals regarding the potential for cervical AVMs as a rare cause of SAH, allowing for prompt intervention and potentially life-saving treatments.
Results:
76-year-old male with medical history of AICD, HTN, CAD, and CHF presented initially complaining of headache associated with distress, confusion, pallor and an inability to walk. Stat stroke imaging including Non-contrast CT Head (NCCTH) and CT Angiogram (CTA) Head and Neck revealed a ruptured cervical spinal arteriovenous malformation (AVM) at C1-C2. Once admitted, further diagnostic assessment included MRI scans, confirming the intracranial and cervical spine pathology. Medical management included Mannitol, 3% saline, and Keppra for seizure prophylaxis, along with blood pressure control. Nimodipine was also started due to concerns for vasospasm with daily transcranial doppler studies. Neurosurgery consultation led to external ventricular drainage (EVD) placement and Neuro Endovascular Surgery onboard for further evaluation via diagnostic cerebral angiogram.