Abstract
Intracranial dural arteriovenous fistulas are abnormal communications between higher-pressure arterial circulation and lower-pressure venous circulation. This abnormal communication can result in important and frequently misdiagnosed neurological abnormalities.A case of rapid onset paraplegia following cervical chiropractic manipulation is reviewed. The patient’s generalized spinal cord edema, lower extremity paraplegia and upper extremity weakness, were initially believed to be a complication of the cervical spinal manipulation that had occurred earlier on the day of admission. Subsequent diagnostic testing determined the patient suffered from impaired circulation of the cervical spinal cord produced by a Type V intracranial arteriovenous fistula and resultant venous hypertension in the pontomesencephalic and anterior spinal veins.The clinical and imaging findings of an intracranial dural arteriovenous fistula with pontomesencephalic venous congestion and paraplegia are reviewed.This case report emphasizes the importance of thorough and serial diagnostic imaging in the presence of sudden onset paraplegia and the potential for error when concluding atypical neurological presentations are the result of therapeutic misadventure.
Highlights
Dural arteriovenous fistulas (DAVF) are abnormal communications between arterial and venous circulation that may arise either spontaneously or as a result of trauma [1]
The frequent association of patients with DAVF and cerebral venous sinus thrombosis [4] indicates spontaneous DAVFs may be the result of venous thrombosis and venous hypertension [5]
The nonaggressive neurological symptoms included isolated headache, bruit and all ocular symptoms not related to intracranial myelopathy
Summary
Dural arteriovenous fistulas (DAVF) are abnormal communications between arterial and venous circulation that may arise either spontaneously or as a result of trauma [1]. Type I, the most common and least aggressive form of DAVF, is based on arterial drainage into an intracranial sinus without flow restriction. The second cervical MR scan, performed two days after admission, revealed increased signal intensity along the path of the pontomesencephic vein anterior to the medulla and the anterior spinal vein as it continues along the anterior surface of the spinal cord. These new MR findings revealed the possible presence of an intracranial DAVF and prompted the performance of a cerebral angiogram.
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