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  • Perinatal/Neonatal Case Presentation
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Perinatal/Neonatal Case Presentation

Catastrophic intrauterine spinal cord injury caused by an arteriovenous malformation

Abstract

We report a baby born with flaccid quadraparesis that was considered possibly attributable to birth injury. Postmortem examination identified an injury that occurred well before delivery caused by hemorrhage from an arteriovenous malformation of the brainstem and spinal cord. We discuss imaging modalities to diagnose neonatal cord injuries, possible treatments, prognosis and end of life decision making for these unfortunate patients. We also emphasize the importance of the autopsy in cases of suspected birth injury.

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References

  1. Tobin WD, Layton Jr DD . The diagnosis and natural history of spinal cord arteriovenous malformations. Mayo Clin Proc 1976; 51: 637–646.

    CAS  PubMed  Google Scholar 

  2. Riche MC, Modenesi-Frietas J, Djindjian M, Merland JJ . Arteriovenous malformations (AVM) of the spinal cord in children. A review of 38 cases. Neuroradiology 1982; 22: 171–180.

    Article  CAS  Google Scholar 

  3. Aminoff MJ, Logue V . Clinical features of spinal vascular malformations. Brain 1974; 97: 197–210.

    Article  CAS  Google Scholar 

  4. Morgan MK, Raymond C, Johnson I, de Silva M . Spinal arteriovenous malformation presenting at birth: case report. Neurosurgery 1986; 19: 637–640.

    Article  CAS  Google Scholar 

  5. Park TS, Cail WS, Delashaw JB, Kattwinkel J . Spinal cord arteriovenous malformation in a neonate. J Neurosurg 1986; 64: 322–324.

    Article  CAS  Google Scholar 

  6. Volpe JJ . Perinatal trauma In: Neurology of the Newborn. 4th edn. Saunders: Philadelphia, 2001, pp 820–825.

    Google Scholar 

  7. Ford FR . Breech delivery in its possible relations to injury of the spinal cord, with special reference to infantile paraplegia. Arch Neurol Psychiatry 1925; 14: 742–750.

    Article  Google Scholar 

  8. Leventhal HR . Birth injuries of the spinal cord. J Pediatr 1960; 56: 447–453.

    Article  CAS  Google Scholar 

  9. Rossitch Jr E, Oakes WJ . Perinatal spinal cord injury: clinical, radiographic and pathologic features. Pediatr Neurosurg 1992; 18: 149–152.

    Article  Google Scholar 

  10. Byers RK . Spinal-cord injuries during birth. Dev Med Child Neurol 1975; 17: 103–110.

    Article  CAS  Google Scholar 

  11. MacKinnon JA, Perlman M, Kirpalani H, Rehan V, Sauve R, Kovacs L . Spinal cord injury at birth: diagnostic and prognostic data in twenty-two patients. J Pediatr 1993; 122: 431–437.

    Article  CAS  Google Scholar 

  12. Menticoglou SM, Perlman M, Manning FA . High cervical cord injury in neonates delivered with forceps: report of 15 cases. Obstet Gynecol 1995; 86: 589–594.

    Article  CAS  Google Scholar 

  13. Odom GL, Woodhall B, Margolis G . Spontaneous hematomyelia and angiomas of the spinal cord. J Neurosurg 1957; 14: 192–202.

    Article  CAS  Google Scholar 

  14. Rand CW . Hemangioma of the spinal cord. Arch Neurol Psychiatry 1927; 18: 755–765.

    Article  Google Scholar 

  15. Wirth Jr FP, Post KD, Di Chiro D . Foix–Alajouanine disease. Spontaneous thrombosis of a spinal cord arteriovenous malformation: a case report. Neurology 1970; 20: 1114–1118.

    Article  Google Scholar 

  16. Kaufman HH, Ommaya AK, Di Chiro G, Doppman JL . Compression vs steal: the pathogenesis of symptoms in arteriovenous malformations of the spinal cord. Arch Neurol 1970; 23: 173–178.

    Article  CAS  Google Scholar 

  17. Aminoff MJ, Barnard RO, Logue V . The pathophysiology of spinal cord vascular malformations. J Neurol Sci 1974; 23: 255–273.

    Article  CAS  Google Scholar 

  18. Menticoglu SM, Perlman M, Manning FJA . High cervical spinal cord injuries in neonates delivered with forceps: report of 15 cases. Obstet Gynecol 1995; 86: 589–594.

    Article  Google Scholar 

  19. Bracken MD, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. N Engl J Med 1990; 322: 1405–1411.

    Article  CAS  Google Scholar 

  20. Bracken MD, Shepard MJ, Collins WF, Holford TR, Baskin DS, Eisenberg HM et al. Methylprednisolone or naloxone treatment after acute spinal-cord injury: 1 year follow-up data. J Neurosurg 1992; 76: 23–31.

    Article  CAS  Google Scholar 

  21. Bracken MD, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M et al. Administration of methylprednisolone for 24 or 48 h or tirilazad mesylate for 48 h in the treatment of acute spinal-cord injury. JAMA 1997; 277: 1597–1604.

    Article  CAS  Google Scholar 

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Correspondence to D M Coulter.

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Coulter, D., Zhou, H. & Rorke-Adams, L. Catastrophic intrauterine spinal cord injury caused by an arteriovenous malformation. J Perinatol 27, 186–189 (2007). https://doi.org/10.1038/sj.jp.7211648

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