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Spinal arteriovenous malformation presenting as spastic monoplegic cerebral palsy in a child
Author(s) -
Flett Peter John,
Baulderstone David,
Russo Remo,
Davies Roger Philip
Publication year - 2012
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.2010.01743.x
Subject(s) - medicine , context (archaeology) , magnetic resonance imaging , arteriovenous malformation , spastic , spinal cord , surgery , cerebral palsy , presentation (obstetrics) , radiology , physical medicine and rehabilitation , paleontology , psychiatry , biology
A case of spinal arterio‐venous malformation (AVM) initially diagnosed as unilateral cerebral palsy (CP) is reported. The presentation was of a long‐standing spastic monoparesis of the left leg, with initial response to Botulinum toxin injections to the calf and tibialis posterior muscles. This was followed by progressive deterioration occurring over a 3‐month period before further investigation and definitive diagnosis at 7 years. Imaging demonstrated a large extra‐medullary spinal AVM compressing the mid‐thoracic cord. This was successfully managed by embolisation with a non‐adhesive polymer: ethylene‐vinyl alcohol copolymer injected into the dominant feeding vessel. This case highlights the need to consider alternative diagnoses when a child with a diagnosis of CP presents with atypical clinical features such as monoparesis and has worsening or altered clinical signs. Moreover, a normal magnetic resonance imaging brain scan and the absence of ipsilateral upper limb neurological signs or functional impairment should raise suspicion even in the context of static lower limb signs. A literature review was performed on the management of spinal AVM in children and this will be is discussed.