Korean J Pain.  2013 Jan;26(1):72-75. 10.3344/kjp.2013.26.1.72.

Spinal Arteriovenous Malformation Masquerating Zoster Sine Herpete

• Lee JY
• Ok SJ
• Oh CK
• Park SK
• Kim DW
• Yang JY

• KMID: 1779028
• DOI: http://doi.org/10.3344/kjp.2013.26.1.72

Abstract

Zoster sine herpete (ZSH) is difficult to diagnosis during an acute period due to the absence of the characteristic zosteriform dermatomal rash; therefore, progression to postherpetic neuralgia is more common than typical zoster. In addition, misdiagnosis of other neuropathic pain as ZSH is common in clinical situations. Here, we report a case of spinal arteriovenous malformation that mimics ZSH. This is a rare condition; therefore, high clinical suspicion for a correct diagnosis and proper examination are not easy. However, early diagnosis and definitive treatment are essential to prevent neurologic deficit and mortality.

Keyword

arteriovenous malformation; herpes zoster; postherpetic neuralgia; zoster sine herpete

MeSH Terms

Arteriovenous Malformations
Diagnostic Errors
Early Diagnosis
Herpes Zoster
Neuralgia
Neuralgia, Postherpetic
Neurologic Manifestations
Zoster Sine Herpete

Figure

• 

  Fig. 1 T spine MR images show about 1.2 cm sized ill-defined intramedullary lesion which has intramedullary nidus and multiple flow voids extension to the dorsal subpial surface is noted in T11-12 level suggesting type II AVM in T11/12 level of spinal cord.

• 

  Fig. 2 Spinal angiogram shows spinal cord AVM feeding from anterior spinal artery from left T9 intercostal artery and left L1 lumbar artery (artery of Adamkiewicz) and nidus of T11 level confirming type 2 spinal arteriovenous malformation, glomus type, T11.

Reference

1. Straus SE, Oxman MN, Schmader KE. Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Varicella and herpes zoster. Fitzpatrick's dermatology in general medicine. 2008. 7th ed. New York: McGraw-Hill;p. 1885–1898.

2. Furuta Y, Ohtani F, Mesuda Y, Fukuda S, Inuyama Y. Early diagnosis of zoster sine herpete and antiviral therapy for the treatment of facial palsy. Neurology. 2000; 55:708–710. PMID: 10980741.

3. Rajbala T, Joel LK, Robert HD. Fishman SM, Ballantyne JC, Rathmell JP, editors. Herpes zoster and postherpetic neuralgia. Bonica's management of pain. 2010. 4th ed. Philadelphia: Lippincott Williams & Wilkins;p. 338–357.

4. Cohen PR. Tests for detecting herpes simplex virus and varicella-zoster virus infections. Dermatol Clin. 1994; 12:51–68. PMID: 8143385.

5. Murray B, Mitsumoto H. Daroff RB, Fenichel GB, Jankovic J, Mazziotta JC, editors. Disorders of upper and lower motor neurons. Bradley's neurology in clinical practice. 2012. 6th ed. Philadelphia: Elsevier;p. 1855–1886.

6. Lewis SL. Weiner WJ, Goetz CG, editors. An approach to neurologic symptoms. Neurology for the non-neurologist. 2004. 5th ed. Philadelphia: Lippincott Williams & Wilkins;p. 21–33.

7. Fisher WS 3rd. Wilkins RH, Rengachary SS, editors. Concomitant intracranial aneurysms and arteriovenous malformations. Neurosurgery. 1996. 2nd ed. New York: McGraw-Hill;p. 2429–2431.

8. Neifeld JP, Doppman JL, Chreitien PB. Congenital pelvic arteriovenous fistulas: report of a case and review of the literature. J Urol. 1975; 114:648–652. PMID: 1235402.

9. Gennuso R, Zappulla RA, Strenger SW. A localized lumbar spinal root arteriovenous malformation presenting with radicular signs and symptoms. Spine (Phila Pa 1976). 1989; 14:543–546. PMID: 2727801.

10. Elhammady MS, Wolfe SQ. Deshaies EM, Eddleman CS, Boulos AS, editors. Aziz-Sultan MA. Spinal arteriovenous malformations. Handbook of neuroendovascular surgery. 2012. 1st ed. New York: Thieme Medical Publishers;p. 375–387.

11. Geldmacher DS. Daroff RB, Fenichel GB, Jankovic J, Mazziotta JC, editors. Vascular diseases of the nervous system: spinal cord vascular disease. Bradley's neurology in clinical practice. 2012. 6th ed. Philadelphia: Elsevier;p. 1095–1102.

12. Riina HA, Soni D, Stieg PE. Batjer HH, Loftus CM, editors. Surgical treatment of spinal arteriovenous malformations. Textbook of neurological surgery: principles and practices. 2003. Philadelphia: Lippincott Williams & Wilkins;p. 2569–2578.

13. Heros RC, Debrun GM, Ojemann RG, Lasjaunias PL, Naessens PJ. Direct spinal arteriovenous fistula: a new type of spinal AVM. Case report. J Neurosurg. 1986; 64:134–139. PMID: 3941336.

14. Caroscio JT, Brannan T, Budabin M, Huang YP, Yahr MD. Subarachnoid hemorrhage secondary to spinal arteriovenous malformation and aneurysm. Report of a case and review of the literature. Arch Neurol. 1980; 37:101–103. PMID: 7356401.

15. Smith BS, Penka CF, Erickson LS, Matsuo F. Subarachnoid hemorrhage due to anterior spinal artery aneurysm. Neurosurgery. 1986; 18:217–219. PMID: 3960303.