ARTERIOVENOUS FISTULA: A COMPLICATION OF VERTEBRAL ANGIOGRAPHY: REPORT OF A CASE.

Abstract

The patient, a 67-year-old white woman, was seen for the first time at the clinic in August 1961, with the chief complaint of pain for 3 weeks in the right arm, shoulder, and neck. The patient stated tlmt she had been in fairly good health until 8 weeks prior to her admission here, when, because of an episode of w'xtigo and diplopia, she was hospitalized elsewhere. All tests performed at that time, including bilateral carotid arid right vertebral angiography, gave negative results (Fig. 1). Her symptoms improved gradually, and she was released from the hospital after weeks. Three weeks thereafter the patient noted pain in tile neck, whicb came on gradually and subsequently spread to the right shoulder and arm. It was constant, sharp, and boring in character, and was accentuated by motion of the neck or right upper extremity. It gradually increased in severity and was followed by rapidly progressive weakness of the right upper extremity. Physical findings were not remarkable except for spasm of the cervical paraspinal muscles on the right, arid minus-4 motor weakness of the right scapular, deltoid, biceps, and 1)rachioradialis muscles, with associated hiss of the appropriate deep tendon reflexes. There was an area of hyperesthesia overlying the right shoulder and upper (C5) arni. One examiner noted a continuous bruit in the neck; it was loudest 2 inches below the right ear. It was thought that compression of the right 5th cervical nerve root, secondary to either a herniated disk or hypertrophic spurring, could explain the complaints. To investigate these possibilities, Pantopaque myelography was performed, and an extradural defect was noted on the right, extending from C3 to C6. TiIe cause and nature of this defect were not readily apparent. A cervical hemilaminectomy with exploration of the 5th arid 6th cervical interspaces revealed no evidence of underlying pathology of tile disks, but abnormal vessels were found compressing the right 5th and 6th cervical roots. The diagnosis of arteriovenous fistula then was nmde, and the significance of the bruit that had been detected previously was appreciated belatedly. Two days later a right subclavian angiogram was made which revealed an arteriovenous fistula involving