Progressive Cervical Myelopathy Caused by Bilateral Spontaneous High-Flow Vertebro-Vertebral Arteriovenous Fistulas Associated with Fibromuscular Dysplasia Successfully Treated by Endovascular V2 Segments Sacrifice Using Fibered Coils: A Case Report

Iampreechakul Prasert,Liengudom Anusak,Siriwimonmas Somkiet,Wangtanaphat Korrapakc,Wattanasen Yodkhwan,Lertbutsayanukul Punjama

doi:10.23937/2378-3656/1410248

Iampreechakul Prasert, Liengudom Anusak + Show 4 more

Open Access

https://doi.org/10.23937/2378-3656/1410248

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Abstract

Highlights

Remaining a disease of unknown etiology, pathogenesis and long- term outcome data, fibromuscular dysplasia (FMD) is non-inflammatory, non-atherosclerotic arteriopathy affecting commonly in renal, extracranial carotid, and vertebral arteries
The authors described a patient with spontaneous bilateral VVAVFs associated with FMD manifested with cervical bruit and progressive myelopathy
The large epidural venous pouch compressing spinal cord from spontaneous VVAVF was found more frequently in the fistula associated with Neurofibromatosis Type 1 (NF1) [21,26,27,28,29,30,31]

Summary

Introduction

Remaining a disease of unknown etiology, pathogenesis and long- term outcome data, fibromuscular dysplasia (FMD) is non-inflammatory, non-atherosclerotic arteriopathy affecting commonly in renal, extracranial carotid, and vertebral arteries. The authors described a patient with spontaneous bilateral VVAVFs associated with FMD manifested with cervical bruit and progressive myelopathy. She suffered from right hemiparesis and bilateral audible bruits without history of trauma She went to the same local hospital and was investigated by CT scan. She was diagnosed as recurrent stroke and obtained echocardiography and doppler ultrasound of both carotid arteries with results of normal study. She was discharged home 2 days later and made appointment in one month. Hanced magnetic resonance angiography (MRA) of the cervical spine showed bilateral high-flow VVAVFs. Enormous dilatation, markedly tortuosity, and irregularity of the V1-V2 segments of both vertebral arteries were apparent. There was a good collateral circulation from bilateral occipital and ascending cervical arteries (Figure 7)

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Conclusion