E-174 Type 1 spinal arteriovenous malformation rupture: a rare culprit of acute spinal subdural hematoma – case report and literature review
Bibliographic record
Abstract
Introduction Type 1 spinal arteriovenous malformations (AVMs) are typically characterized by dural fistulas that manifest as progressive congestive myelopathy. However, acute hemorrhage resulting in spinal subdural hematoma is extremely uncommon, with only three documented cases reported to date. Materials and Methods A 46-year-old female presented with rapidly progressive paraplegia that developed over the course of several hours. There was no history of anticoagulant use, trauma, fever, or infection. Upon examination, the patient exhibited bilateral lower extremity weakness (graded as 0/5) and decreased sensation to pinprick below the T6 level on both sides. Loss of bowel and bladder control was also noted. MRI revealed the presence of an intradural extramedullary lesion situated anteriorly, causing significant compression on the spinal cord from the T4 down to T7 level. The patient underwent thoracic laminectomy from T4-T7, followed by the evacuation of a well-organized subdural hematoma that was exerting significant mass effect on a distorted spinal cord upon dural opening. During the procedure, a large abnormal artery was identified, leading into a dilated serpiginous vein located on the dorsal aspect of the spinal cord at the T7 level. Further examination utilizing indocyanine green angiography confirmed our suspicion of a dural arteriovenous fistula, which was then successfully disconnected. Results Based on the findings from the literature review (table 1), all patients who presented with the rapid onset of neurological symptoms were female. Due to the complex clinical presentation, treatment was delayed. Out of the three cases, only one was confirmed to have a dural AVF with angiography, while the other two required exploratory spinal decompression for diagnosis. However, all patients achieved full recovery to their prior level of functioning. These data suggest that patients who present with back or neck pain and neurological symptoms should undergo comprehensive evaluations to determine the presence of hemorrhages that may lead to spinal cord compression. In cases where hematomas are identified, surgical intervention may be necessary to prevent neurological deficits. Additionally, vascular abnormalities, such as AVFs, should be considered as potential causes of spinal hemorrhage. Conclusion In rare instances, type I spinal arteriovenous malformations (AVMs) may present acutely as a subdural hematoma and should thus be considered as a possible differential diagnosis for acute paraplegia. Disclosures A. Naeem: None. A. Shamisa: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".