Abstract Details

Title Simultaneous Epidural and Intramedullary Hemorrhage: A Case Report.

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-023

Objective We report a simultaneous thoracic epidural and intramedullary hemorrhage in a young woman with a venolymphatic fistula, which has not previously been described. Venous, lymphatic and combined vascular malformations are characterized by abnormally dilated vasculature that are present at birth but may enlarge with age. As low-flowing lesions, they do not typically present with acute hemorrhage.

Background A twenty-one-year-old woman presented with one day of spontaneous, progressive back pain, and stuttering onset of right leg weakness and numbness. Examination showed right leg 4/5 strength, patchy alterations in light touch, pain and temperature, brisk reflexes with cross-adductors and a Babinksi response. There were no stigmata of connective tissue disorders. Prothrombin time and D-dimer were mildly elevated. MRI showed a lobular, partially-hemorrhagic lesion with multiple phleboliths traversing the left pleural space, posterior chest wall, upper thoracic neural foramina, and posterolateral epidural spaces from C7 - T4. This resulted in severe posterior lateral compression of the spinal cord in the upper thoracic region with associated intramedullary blood. She underwent a multilevel laminectomy for decompression of the spinal lesion from C7 to T3. A large epidural hematoma was evacuated, and multiple dilated veins were found. Her lesion was determined to be a large venolymphatic fistula. At follow up, her only symptoms were leg dysesthesias.

Design/Methods *

Results *

Conclusions Venolymphatic malformations are a rare cause of hemorrhage in adults and have not previously been described to cause a compressive myelopathy. They usually present in childhood with pain, stasis, and swelling. Several case series have attempted to elucidate the subset of patients that are likely to have complications such as hemorrhage or thrombosis. It is thought that the stagnation in blood flow promotes thrombosis and fibrin consumption resulting in a localized intravascular coagulopathy. This coagulopathy, present in our patient, is thought to be indicative of an increased probability of complications.

Authors/Disclosures
Shailee S. Shah, MD PRESENTER	Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Shah has received publishing royalties from a publication relating to health care.
Christina Lineback, MD (McGaw Medical Center of Northwestern University)	Dr. Lineback has nothing to disclose.
Richard A. Bernstein, MD (Northwestern University)	No disclosure on file

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