SHM Converge Scientific Abstract ePoster Gallery-When Common Symptoms Hide Rare Pathology: A Case of Spinal Avm Rupture

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This case describes a 19-year-old woman who initially presented with sudden mid-back and right shoulder pain and was treated for presumed muscle spasm. She later returned with hypoxia and CT chest findings of ground-glass opacities, leading to treatment for pneumonia. On further evaluation, however, she had significant neurologic deficits: inability to lift her arms, left foot drop, decreased lower-extremity sensation, absent reflexes, urinary retention, and loss of rectal tone. These findings prompted emergent MRI of the brain and spine.<br /><br />Imaging revealed extensive hemorrhagic lesions from approximately C2 to T6 causing severe spinal cord compression. Spinal angiography confirmed a ruptured cervical spinal cord arteriovenous malformation (AVM) with associated cervicothoracic intramedullary hematoma. She underwent urgent C3-C6 laminectomy, AVM resection, hematoma evacuation, and duraplasty. Despite treatment, she developed tetraparesis and now has persistent right-sided hemiparesis after intensive rehabilitation.<br /><br />The discussion emphasizes that spinal vascular malformations are rare but serious causes of acute spinal cord dysfunction. Hemorrhagic presentations are especially uncommon in young patients without trauma and are often misdiagnosed because symptoms can begin with nonspecific pain or subtle neurologic changes. In this case, the initial pulmonary findings contributed to diagnostic anchoring, delaying recognition of the underlying neurologic emergency.<br /><br />The key lesson is that early neuroimaging and a broad differential are essential when young patients present with acute back pain plus evolving neurologic deficits. Rapid diagnosis and multidisciplinary treatment are critical to limiting permanent neurologic injury and preventing rebleeding.

Asset Subtitle

Nicole Mintz

Meta Tag

Author List Amee Amin, Andreea S. Xavier, Benjamin Clark, Nicole Mintz, Rao Afzal

Category Clinical Vignettes

Concept Neurologic Deficit

Concept Acute Myelopathy

Concept Arteriovenous Malformation

Concept Spinal Vascular Lesion

Concept Weakness

Distinguished Non-Finalist

Presenter Organization UTHealth Houston at McGovern, Memorial Hermann - Texas Medical Center

Presenting Author Nicole Mintz

Track Adult

Keywords

spinal arteriovenous malformation

intramedullary hematoma

spinal cord compression

hemorrhagic lesion

acute back pain

neurologic deficits

MRI spine

spinal angiography

laminectomy

tetraparesis

Neurologic Deficit

Acute Myelopathy

Arteriovenous Malformation

Spinal Vascular Lesion

Weakness