Acute Spinal Hemorrhage from a Cauda Equina Arteriovenous Fistula Fed by the Proximal Radicular Artery

Abstract

Spinal cauda equina arteriovenous fistulas (CEAVFs) and spinal hemorrhage from spinal AVF are relatively unusual. To our knowledge, such a case of CEAVF presenting with hemorrhage has not been reported. Here, we describe such a rare case of CEAVF. Spinal magnetic resonance imaging and angiography revealed a CEAVF at the L2 level, fed by the proximal radicular artery and with 2 associated venous varices. Considering the feeder from the proximal radicular artery and the presence of acute hemorrhage, direct surgery was performed. Intraoperatively, spinal hematoma and the fistula were identified at the L2 level. The fistula was clipped and divided successfully. The postoperative course was uneventful. CEAVF presenting with spinal hemorrhage is extremely rare. This case demonstrated the angioarchitecture features of CEAVF. The clinicians should be aware of the possibility of this condition and the importance of treatment selection.