Sudden quadriplegia in a young female

So to begin with, I have a term for you-Spinal arteriovenous malformations (AVMs). they are very rare causes of spinal space occupying lesions. They can remain silent for a long time but they can also cause catastrophic consequences once symptoms begin. Improvements in interventional radiology and neurosurgery have led to better outcomes in the treatment of spinal arteriovenous malformations, provided they are detected in time.

Researchers have recently reported a catastrophic presentation of spinal arteriovenous malformations.the study I am talking about is published in the JAPI. A 13-year-old female patient presented with sudden onset weakness of all four limbs.

The patient was watching television on the couch when she felt these tingling sensation in her legs, followed by hands and this was rapidly followed by weakness of all four limbs over the next half hour. The patient was admitted to a nearby hospital where she was found to have complete flaccid quadriplegia with urinary retention. However, on the second day, she developed respiratory distress.

At presentation in the critical care unit, the patient was having tachypnea. She was quickly scheduled for cervical spine magnetic resonance imaging (MRI) with contrast. On the second day, her dyspnea increased with single breath count of six and falling oxygen saturation. She was quickly intubated and put on mechanical ventilation. Meanwhile, the MRI reports were available, which showed arteriovenous malformations of the cervical spine and cervicomedullary junction with acute bleed inside the cervical spinal cord. Thus, this was the cause of her sudden quadriplegia.

The patient was on ventilation and surgery was planned after angiography. But before anything could be done, she suffered a cardiac arrest could not come out of it.

So, spinal dural arteriovenous malformations are acquired diseases although their etiology still remains unknown.

Treatment options for such arteriovenous malformations include microsurgery, embolization, or even both. But in some cases, the location of the arteriovenous malformations may preclude surgery. Now, newer technologies like Cyberknife are being used for such cases.

Researchers therefore concluded that this case did sensitize clinicians to this rare cause of quadriplegia in the young. So such cases do need urgent management by a multidisciplinary team.

Reference: Manotosh Sutradhar, Indranil Thakur, Subinay Chhaule, et al; Sudden Quadriplegia in a Young Female, volume issue:70, JAPI.