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Rehabilitation Practice and Science

Translated Title

延遲診斷之脊髓動靜脈畸形及其泌尿系統併發症之處理：病例報告

Abstract

Spinal arteriovenous malformations (Spinal AVM) are a rare disorder with an estimated incidence of about 1 per million people per year. Because of the diversity of the presenting symptoms, this disorder is difficult to diagnose, despite new advances in neuronimaging. We report the case of a girl who was diagnosed at 12 years old to have spinal AVM at a high cervical level and presented with four limbs weakness and dyspnea. She was found to have extremely high voiding pressure and a rapid development of grade 2 vesicoureteral reflux (VUR), which was thought to be a chronic complication after spinal cord injury. reviewarticle of her history revealed that she had experienced a previous episode of intracranial subarachnoid hemorrhage at the age of 9 with negative intracranial angiography; no definite diagnosis was given. Urologic symptoms had been noted since then, and they became exacerbated one year before her definite diagnosis. No evaluation or treatment was given for this problem, and we speculate that she may have had neurogenic bladder with high voiding pressure for a long time, which resulted in VUR. We prescribed an indwelling catheter with an oral anticholinergic agent to relieve the high intravesical pressure. A subsequent videourodynamic study showed decreased intravesical pressure and the elimination of VUR.This article presents the clinical characteristics of spinal AVM in a single patient and seeks to remind physicians that spinal AVM should be included in the differential diagnosis for patients who have had intracranial subarachnoid hemorrhage and negative intracranial angiography. In addition, we discuss neurogenic bladder dysfunction after spinal AVM and its management.

Language

Traditional Chinese

First Page

259

Last Page

264

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