Abstract
Background: Spinal dural arteriovenous fistula is a rare and underdiagnosed disorder. Because of the nonspecific clinical presentation of the condition, patients are often referred to different specialists, resulting in delayed diagnosis.Case Report: A 76-year-old male presented with a 1-month history of gait trouble. His impairment was asymmetric, distally predominant, sensitive, and motor. Symptoms worsened with standing and walking. The patient also had sphincterial dysfunction. Classic spinal cord magnetic resonance imaging (MRI) showed an extended hypersignal indicating nonspecific myelopathy. Repeat spinal cord MRI that included a T2 spin echo sequence revealed abnormalities suggesting dural arteriovenous fistula. Medullar angiography confirmed the diagnosis, and endovascular treatment was successfully performed. Six months posttreatment, the patient reported resolution of his neurologic disabilities except for some residual paresthesia in his inferior limbs.Conclusion: Physicians should be aware of the specific abnormalities shown on spinal cord MRI that indicate dural arteriovenous fistula, as well as the criteria for performing medullar angiography, so that the condition can be diagnosed and treated in a timely manner. Early therapeutic treatment is the principal prognosis factor.
Highlights
Spinal dural arteriovenous fistula is a rare and underdiagnosed disorder, the condition has a characteristic neuroradiologic presentation that can indicate the diagnosis
We present the case of a patient with a spinal dural arteriovenous fistula that highlights the importance of the neuroradiologist’s experience and collaboration with the clinician for a rapid and correct diagnosis that resulted in timely interventional treatment
A second medullar angiography performed by an experienced neuroradiologist allowed definite diagnosis of a left T4-level spinal dural arteriovenous fistula (Figures 2B and 2C)
Summary
Celine Derollez, PhD,[1] Celine Tard, PhD,[1,2] Apolline Kazémi, PhD,[3] Patrick Vermersch, MD,[1,4] Jean-Pierre Pruvo, MD2,3
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