LAUSR

The authors report on a 59-year-old man with a vertebro-vertebral arteriovenous fistula (VVAVF) who developed massive intramedullary hemorrhage. Twelve months prior to ictus, the patient presented with subarachnoid hemorrhage. Although we recommended endovascular surgery, the patient refused treatment. Twelve months after the initial attack, the massive intramedullary hemorrhage in cervical spinal cord caused complete spinal cord injury. Emergent endovascular intervention was performed following the intramedullary hemorrhage, but there was no neurological improvement. Hemorrhagic presentations are rare in VVAVF. To the best of our knowledge, this is the first report of a patient initially presenting with subarachnoid hemorrhage and progressing to intramedullary hemorrhage. Identification of this phenomenon is important in VVAVF because intramedullary hemorrhage dramatically degrades patient outcome. Early diagnosis and prompt surgical intervention is mandatory for VVAVF cases presenting with subarachnoid hemorrhage.