Rapid surgical intervention for acute spinal subdural hematoma triggered by ruptured spinal dural arteriovenous fistula: illustrative case
Bibliographic record
Abstract
BACKGROUND: Spinal dural arteriovenous fistulas (dAVFs) are rare vascular malformations that typically cause progressive congestive myelopathy. Hemorrhagic presentations of dAVFs, such as subdural hematomas (SDHs), are exceedingly rare and can lead to acute neurological deterioration. OBSERVATIONS: The authors present a case of spinal SDH secondary to a ruptured spinal dAVF. A 46-year-old woman presented with rapidly progressing paraparesis to complete paralysis within hours, without a history of trauma, anticoagulation, or infection. Thoracic spine MRI revealed an intradural, ventral extramedullary lesion from T4 to T7, consistent with a compressive hematoma. The patient underwent a thoracic laminectomy for evacuation. Intraoperative indocyanine green angiography identified a spinal dAVF near the left T7 nerve root sleeve, which was successfully clipped. At the 9-month follow-up, the patient had significantly recovered with 4/5 strength in her lower extremities. LESSONS: This is the fourth documented instance of a spinal dAVF presenting as a spinal SDH. Clinicians should consider this diagnosis in patients with acute paraplegia, back pain, and sphincter dysfunction, especially without trauma or coagulopathy. Diagnosis may be complicated by angiographically occult lesions due to a hematoma mass effect, making intraoperative imaging essential. Prompt surgical decompression and fistula disconnection can yield significant neurological recovery, as demonstrated in this case and limited literature. https://thejns.org/doi/10.3171/CASE25510.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".