Unilateral Knee Pain as Clinical Presentation of Spinal Dural Arteriovenous Fistula: A casereport

Abstract

Spinal dural arteriovenous fistula (SDAVF) is a rare disease. The principal clinical manifestation of SDAVF is myelopathy, with variable but nonspecific symptoms including progressive weakness of the lower extremities, back pain, bowel and bladder dysfunction, and impotence. Diagnosis is often delayed. Knee pain as the chief complaint of SDAVF is rare. The present case report describes a 49-year-old man with a history of SDAVF, for which he had twice received endovascular embolization, who presented with profound pain in the right knee when attending the study rehabilitation clinic. He had no history of trauma. Physical examination revealed upper motor neuron signs in bilateral lower extremities. Imaging studies of the right knee, including X-ray and sonography, revealed no structural lesion to which his clinical presentation could be attributed. Nerve conduction velocity and electromyography examination showed no evidence of radiculopathy or peripheral neuropathy. Digital subtraction angiography (DSA) identified recurrent SDAVF. It was, thus, believed that the patient's profound right knee pain was the presentation of persistent myelopathy caused by recurrent SDAVF. Early diagnosis and treatment of SDAVF can improve patient's prognosis. Treatment options include endovascular embolization and open spinal surgery. When treating patients with SDAVF, physicians should keep in mind that although two-thirds of these patients can experience motor recovery, only one-third show improvements in sensory disturbances, and pain might persist. (Tw J Phys Med Rehabil 2012; 40(2): 85 - 90)