1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-12-62-a 10.15844/pedneurbriefs-12-8-9 Vascular Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Basal Ganglia A-V Malformation and Writer’s Cramp http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 08 1998 01 05 2016 12 8 62 62 Copyright: © 1998 The Author(s) 1998 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Basal ganglia arteriovenous malformation presenting as “writer's cramp”

A 12-year-old girl presenting with writer’s cramp as the first manifestation of basal ganglia arteriovenous malformation (AVM) is reported from the Department of Neurosurgery, University of Tokyo, Japan.

 Manifestation of Basal Ganglia Arteriovenous Malformation Writer’s Cramp Lenticulostriate Arteries

A 12-year-old girl presenting with writer’s cramp as the first manifestation of basal ganglia arteriovenous malformation (AVM) is reported from the Department of Neurosurgery, University of Tokyo, Japan. Difficulty in writing caused by too firm a pen grasp developed at 9 years of age and progressively worsened until at 11 years, she had weakness and involuntary movements of the right hand. At 12 years, she had severe headache with nausea and vomiting. MRI showed an unruptured left basal ganglia AVM localized to the globus pallidus and putamen, and extending to the left frontal lobe white matter. Cerebral angiography revealed a large high-flow AVM fed by lenticulostriate arteries. Treated conservatively, the dystonic cramp and weakness have not progressed during one year follow-up. [1]

COMMENT. AV malformation presenting as writer’s cramp is a novel case-report. The location and size of the lesion appear to have prompted conservative management. A review of the literature in 1994 revealed that AVM mortality was 23-57% with conservative management versus 8.5-11% postoperatively. The smaller the AVM, the higher the risk of hemorrhage and the greater the indication for surgery. (See Progress in Pediatric Neurology III, PNB Publ, 1997;p458).

Kurita H Sasaki T Suzuki I Kirino T Basal ganglia arteriovenous malformation presenting as “writer's cramp” Child's Nerv Syst 1998 Jun 14 6 285 287 10.1007/s003810050227 9694342