Case of Cowden Syndrome with 15 Spinal Arteriovenous Fistulas
| Autor: | Abderrahmane Hedjoudje, Daniel M. Sciubba, Xiao Peng, Ayushi Gautam, Carlos A. Pardo, Philippe Gailloud |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Hemodynamics Arteriovenous fistula 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Lumbar medicine Humans Central Nervous System Vascular Malformations medicine.diagnostic_test business.industry Thyroid Magnetic resonance imaging Digital subtraction angiography Cowden syndrome Middle Aged medicine.disease Vascular endothelial growth factor medicine.anatomical_structure Spinal Cord chemistry 030220 oncology & carcinogenesis Arteriovenous Fistula Female Surgery Neurology (clinical) Radiology Hamartoma Syndrome Multiple business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 139:567-576 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2020.04.086 |
| Popis: | Background Spinal vascular malformations are rarely multiple: fewer than 50 observations have been documented so far, with a maximum of 4 coexisting lesions per patient, always restricted to a single vertebral region (e.g., cervical or thoracic). Case Description We describe the case of a 61-year-old woman with Cowden syndrome with 15 spinal arteriovenous fistulas (AVFs) at the cervical, thoracic, and lumbar levels and an adrenal AVF. She was initially referred for reevaluation of an upper cervical spinal epidural spinal arteriovenous fistula diagnosed 6 years earlier. Her history included breast carcinoma, a malignant salivary gland tumor, and removal of multiple ovarian, thyroid, and gastric hamartomas. Computed tomography and magnetic resonance imaging confirmed the presence of a prominent cervical vascular lesion. Spinal digital subtraction angiography revealed the presence of 15 additional vascular anomalies. Conclusions This multiplicity of AVFs appears to result from a combination of various factors including local regional hemodynamic changes, growth factor-mediated alterations involving notably vascular endothelial growth factor pathways, and the prothrombotic state associated with abnormalities in blood vessel structure. |
| Databáze: | OpenAIRE |
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