Spinal Arteriovenous Malformation Masquerating Zoster Sine Herpete
A 36-year-old man with an itching and tingling sensation in the left L2 dermatome area for 3 months was referred to our clinic for pain management. The patient did not have significant past medical history, and before coming to the clinic, he had been treated with gabapentin 600 mg 3 times a day by a dermatologist but the symptoms were not improved. There were no unusual finding in the biopsy other than subcorneal pustules, hyperkeratosis and parakeratosis; therefore, he was referred to our department for pain control. The character was continuous tingling and itching, and it was aggravated when humid. He was also complaining of allodynia and paresthesia, and his visual analogue scale (VAS) was 2 out of 10 (0 = no pain, 10 = worst possible pain). His motor function was intact and there was no sensory loss. His knee jerk reflex was increased (3+/3+) thus a thoraco-lumbar spine magnetic resonance imaging (T-L MRI) was performed due to suspicion of an upper motor neuron (UMN) lesion. In the MRI, an intramedullary lesion 1.2 cm in size was found in the dorsal subpial surface of the T11-12 level, and this was diagnosed as type II AVM in the T11/12 level of the spinal cord ().\nA spinal angiography was performed on the patient and the results revealed that the lesion was a spinal cord AVM supplied by the anterior spinal artery from the left T9 intercostal artery. It was also contrasted from the left L1 lumbar artery (Artery of Adamkiewicz) ().\nThe patient was transferred to another hospital for removal of AVM with cyber knife, and after the operation, the symptoms were improved.