Sudden-onset paraplegia in a 72-year-old male with a spinal dural arteriovenous fistula: illustrative case

Author:

Ogbu Ikenna I.1,Tzerakis Nikolaos1,Al-Shamary Zaineb2

Affiliation:

1. Department of Neurosurgery, Royal Stoke Hospital, University of North Midlands NHS Trust, Staffordshire, United Kingdom; and

2. School of Medicine, Keele University, Staffordshire, United Kingdom

Abstract

BACKGROUND Spinal dural arteriovenous fistulas (SDAVFs) are rare vascular malformations of the spine but account for up to 80% of all vascular malformations involving the spine. Few case reports of SDAVFs have been reported in the literature, and even fewer have been described with sudden onset of symptoms. OBSERVATIONS The authors described the case of a 72-year-old male with sudden-onset bilateral paraplegia and sensory loss with subsequent inability to bear weight and an initial suspicion of cauda equina syndrome, which was eventually diagnosed as an SDAVF using magnetic resonance imaging. During open surgery, it was difficult to identify the feeder vessels. A postoperative scan showed persistence of the fistula, and the patient had to receive redo ligation with good postoperative status. LESSONS Sudden-onset paraplegia is not the typical presentation of SDAVF. All doctors need to be aware of the possibility of an acute presentation with SDAVF, especially with the high likelihood of misdiagnosis and resultant worse outcome due to treatment delays. A high index of suspicion is required to ensure early recognition as well as initiation of treatment.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Management Science and Operations Research,Mechanical Engineering,Energy Engineering and Power Technology

Reference26 articles.

1. Congestive myelopathy (Foix-Alajouanine syndrome) due to intradural arteriovenous fistula of the filum terminale fed by anterior spinal artery: case report and review of literature;Krishnan;Ann Indian Acad Neurol,2013

2. Spinal dural arteriovenous fistulas: clinical features in 80 patients;Jellema;J Neurol Neurosurg Psychiatry,2003

3. Peripheral spinal cord hypointensity on T2-weighted MR images: a reliable imaging sign of venous hypertensive myelopathy;Hurst;AJNR Am J Neuroradiol,2000

4. Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview;Fugate;Neurosurg Focus,2012

5. Spinal dural arteriovenous fistulas;Krings;AJNR Am J Neuroradiol,2009

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