Spinal dural AV fistula: A nightmare for the anaesthesiologist

Lokvendra Singh Budania,Manjunath Prabhu,Yogesh K Gaude,Meghna Reddy,M V Eeshwar,Vamshidhar Chamala Reddy

doi:10.4038/slja.v27i2.8428

Lokvendra Singh Budania, Manjunath Prabhu + Show 4 more

Open Access

https://doi.org/10.4038/slja.v27i2.8428

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Abstract

Spinal dural arteriovenous fistulas (SDAVFs) are abnormal connections between radicular arteries and venous plexus of the spinal cord. SDAVFs most commonly present with pain and weakness in the lower limbs (which presents as difficulty in climbing stairs, gait disturbances)and sphincter dysfunction that is gradually progressive. We present a 31 year old woman who was diagnosed with stress urinary incontinence and was scheduled for tension free vaginal taping. Spinal anaesthesia was administered and post operatively the patient developed myoclonic jerks and weakness of the lower limbs. On evaluation she was found to have lumbar spinodural AV fistula.

Highlights

Spinal dural arteriovenous fistulas (SDAVFs) are abnormal connections between radicular arteries and venous plexus of the spinal cord
The incidence of SDAVFs is about 5-10 new cases per million persons per year.13We report a 31 year old woman who was diagnosed with stress urinary incontinence and was scheduled for tension free vaginal taping
Case report A 31-year-old woman presentedwith inability to micturate voluntarily but ability to pass urine while straining or coughing for the past 2 months. She was diagnosed with stress urinary incontinence (SUI)

Summary

Introduction

Spinal dural arteriovenous fistulas (SDAVFs) are abnormal connections between radicular arteries and venous plexus of the spinal cord. Spinal anaesthesia was administered and post operatively the patient developed myoclonic jerks and weakness of the lower limbs. On evaluation she was found to have lumbar SDAVF. Case report A 31-year-old woman presentedwith inability to micturate voluntarily but ability to pass urine while straining or coughing for the past 2 months She was diagnosed with stress urinary incontinence (SUI). It was found that she had distal hypotonia in both lower limbs and a graded sensory loss up to dermatomes T11-T12 She was catheterised in view of difficulty in voiding and a nerve conduction study was performed which was normal. We probed into her past history, which revealed that she had started experiencing weakness in both lower limbs for the past 6 months after childbirth. Due to the unavailability of the above facilities at our centre, the patient was referred to a centre with said facility

Discussion

Conclusion