ArticleJournal of neurosurgery. Case lessons2026
Delayed identification and treatment of a cervicomedullary spinal vascular lesion following angiogram-negative, high-grade subarachnoid hemorrhage: illustrative case.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAn angiogram-negative subarachnoid hemorrhage (SAH) with a high Hunt-Hess grade and atypical radiographic features warrants evaluation for occult lesions. Cervicomedullary spinal arteriovenous malformations (AVMs) are rare causes frequently missed on initial imaging. OBSERVATIONS: A 54-year-old male presented with a Hunt-Hess grade V SAH, and initial multimodal angiography findings were negative. Neurological status improved following external ventricular drain (EVD) placement. Imaging clues included a focal ventral cervicomedullary spot sign, disproportionate prepontine blood accumulation with inferior tracking, and an intraventricular hemorrhage. Angiography performed on day 10 revealed a 3-mm ruptured anterior spinal artery (ASA) aneurysm with cervicomedullary AVM. Endovascular treatment was high risk given the proximity of the ASA. Resection via far-lateral transcondylar approach was performed. Neuromonitoring demonstrated bilateral motor evoked potential (MEP) decline with preserved D-wave amplitude, prompting reinspection, revealing an inadvertent ASA trunk clipping, and enabling correction and complete MEP recovery. The lesion was obliterated without deficits. LESSONS: In a high-grade, angiogram-negative SAH, ventral blood distribution and spot signs should prompt targeted spinal angiography at 7-14 days. EVD placement can reverse herniation and coma in high-grade presentations. The far-lateral approach and cord rotation provide direct visualization for ventral spinal pathology when endovascular access is restricted. D-wave monitoring with transcranial MEPs enables real-time distinction between reversible ischemic changes and irreversible mechanical injury, guiding intraoperative decision-making. https://thejns.org/doi/10.3171/CASE26229.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.