medication question

Posted By  CCF NEUROSURGERY MD on August 14, 1997 at 12:08:16:

In Reply to: medication question posted by carolyn kowalski on July 24, 1997 at 11:39:24:

: if a patient with an arteriovenous malformation in their spine has a "Stroke" that is the avm distends and hemmorhages and damages the spinal cord would immediate use of methylprednisone (steroid to reduce inflammation and counteract damaging chemical changes ) be indicated?  Could the use of this steroid sooner after thw injury prevent or reduce further damage?please answer soon it's very important

[CCF NEUROSURGERY MD]

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Dear Carolyn,
AVM's of the spinal cord are a rare condition.  They are defined as an
abnormal connection between the arterial and venous systems in the spinal
cord.  An AVM may cause symptoms by a few mechanisms: hemorrhage, local
mass effect, and the 'steal' effect.  Steal is a condition where the
higher flow of blood in the AVM literally 'steals' blood away from normal
tissues and may cause a neurological deficit.  
In the specific incidence of hemorrhage of a spinal cord AVM there are no
good studies which show a benefit to steroids, i.e. methylprednisolone.  
There may be a theoretical benefit to steroids in terms of reducing swelling
in this situation, but no literature has supported this assertion.  Steroids
are not the standard of care in this setting.  Steroids are commonly used in
the instance of acute spinal cord trauma and to treat swelling associated
with tumors, for example.
If you do indeed have a spinal cord AVM that has bled in the past, a second
opinion on your options may be wise.  Consultation with a neurosurgeon
who has experience with spinal cord AVM's may be of great benefit to you.  
The risks to you may include a variably progressive neurological deficit for
the reasons discussed above, depending on the location of the AVM.  The
treatment options include surgery, endovascular therapies, radiation, and
observation alone.  It is difficult to give an accurate assessment of your
particular situation without knowing a history and seeing the diagnostic
studies that have been done.  You may choose to review your history, MRI and
angiographic films with an experienced neurosurgeon to better assess your
particular risk for further complications.  The Cleveland Clinic may be able
to assist you if you so desire.
Good luck.