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Abruzzo T, van den Berg R, Vadivelu S, Hetts SW, Dishop M, Cornejo P, Narayanan V, Ramsey KE, Coopwood C, Medici-van den Herik EG, Roosendaal SD, Lawton M, Bernes S. Arterioectatic Spinal Angiopathy of Childhood: Clinical, Imaging, Laboratory, Histologic, and Genetic Description of a Novel CNS Vascular Pathology. AJNR Am J Neuroradiol 2022; 43:1060-1067. [PMID: 35772802 DOI: 10.3174/ajnr.a7551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/18/2022] [Indexed: 11/07/2022]
Abstract
Pediatric patients with myelopathy expressing intradural spinal vascular ectasia without arteriovenous shunting were studied at four tertiary referral neuropediatric centers. Patients were identified by retrospective review of institutional records and excluded if spinal vascular pathology could be classified into a previously described category of spinal vascular malformation. Four patients meeting the study criteria were enrolled in the study. Clinical, magnetic resonance imaging, catheter-directed angiography, laboratory, histological and genetic data were analyzed to characterize the disease process and elucidate underlying pathomechanisms. Our study revealed a highly lethal, progressive multi-segmental myelopathy associated with a unique form of non-inflammatory spinal angiopathy featuring diffuse enlargement and tortuosity of spinal cord arteries, spinal cord hyperemia, and spinal cord edema (Arterioectatic Spinal Angiopathy of Childhood). The condition was shown to mimic venous congestive myelopathy associated with pediatric spinal cord arteriovenous shunts on MRI but to have distinct pathognomonic findings on catheter-directed angiography. Clinicopathological, genetic, and neuroimaging features, which are described in detail, closely overlap with those of mitochondrial disease.
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Affiliation(s)
- T Abruzzo
- From the Barrow Neurological Institute at Phoenix Children's Hospital and Department of Radiology (T.A., P.C., S.B.) .,Department of Child Health (T.A., M.D., P.C., S.B.), College of Medicine, University of Arizona, Phoenix, Arizona
| | - R van den Berg
- Department of Radiology and Nuclear Medicine (R.v.d.B., S.D.R.), Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - S Vadivelu
- Department of Neurosurgery (S.V.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - S W Hetts
- Department of Radiology (S.W.H.), University of California, San Francisco, San Francisco, California
| | - M Dishop
- Department of Pathology and Laboratory Medicine (M.D.).,Department of Child Health (T.A., M.D., P.C., S.B.), College of Medicine, University of Arizona, Phoenix, Arizona
| | - P Cornejo
- From the Barrow Neurological Institute at Phoenix Children's Hospital and Department of Radiology (T.A., P.C., S.B.).,Department of Child Health (T.A., M.D., P.C., S.B.), College of Medicine, University of Arizona, Phoenix, Arizona
| | - V Narayanan
- Translational Genomics Research Institute (V.N., K.E.R.), Phoenix, Arizona
| | - K E Ramsey
- Translational Genomics Research Institute (V.N., K.E.R.), Phoenix, Arizona
| | - C Coopwood
- College of Medicine (C.C.), University of Arizona, Tucson, Arizona
| | | | - S D Roosendaal
- Department of Radiology and Nuclear Medicine (R.v.d.B., S.D.R.), Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - M Lawton
- Department of Neurosurgery (M.L.), Phoenix Children's Hospital, Phoenix, Arizona
| | - S Bernes
- From the Barrow Neurological Institute at Phoenix Children's Hospital and Department of Radiology (T.A., P.C., S.B.).,Department of Neurology (S.B.).,Department of Child Health (T.A., M.D., P.C., S.B.), College of Medicine, University of Arizona, Phoenix, Arizona
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