Spinal cord arteriovenous malformation in a toddler presenting with altered mental status and fever

Abstract Central nervous system arteriovenous malformations (AVMs) are a rare cause of subarachnoid hemorrhage and neurologic deficits. About 90% of these lesions are supratentorial, with a smaller percentage occurring in the posterior fossa and an even smaller number found throughout the spine. Although spinal AVMs are uncommon, these disorders represent a treatable cause of significant morbidity in a young age group. We report a case of a T11-T12 spinal AVM in a 14-month-old girl presenting with low-grade fever and lethargy who was found to have subarachnoid hemorrhage on evaluation and describe a reasonable stepwise approach to these patients in the emergency department utilizing computed tomography, lumbar puncture, magnetic resonance imaging, and angiography.