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A 35 year-old man presented with progressive quadriparesis and numbness in four extremities.
Cerebral Angiogram (Left Vertebral Injection). A large arteriovenous malformation can be seen arising from the vertebral artery in the neck. Near the top of the picture, the Posterior Inferior Cerebellar Artery (PICA) is seen arising from the intracranial Vertebral artery. Remember, the anterior spinal artery first arises from the vertebral arteries. Spinal AVMs are rare congenital malformations. They can present acutely from an infarction or hemorrhage, or can presently in a slow or stepwise manner over years. They are potentially treatable by neurosurgery or endovascular procedures.
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