Spinal cord arteriosclerosis and progressive vascular myelopathy.

We report a case of a 68-year-old woman with an acute paraplegia due to venous congestion of the spinal cord caused by an exclusive epidural arteriovenous fistula. Diagnosed by MRI and selective spinal angiography the fistula was embolized during emergency treatment via transarterial access. Immediately after the intervention the paraplegia declined and the patient recovered completely. Epidural AV fistulae are a very rare and therefore relatively unknown cause of vascular myelopathy. They may require emergency management to avoid permanent neurological deficits.

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Cervical spinal dural fistulas leading to remote thoracolumbar myelopathy

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000724 ◽

2019 ◽

Vol 10 (4) ◽

pp. 340-343

Author(s):

Mesha Martinez ◽

Abderrahmane Hedjoudje ◽

Carlos Pardo ◽

Rafael J. Tamargo ◽

Philippe Gailloud

Keyword(s):

Spinal Cord ◽

Cervical Spinal Cord ◽

Venous Drainage ◽

Venous Hypertension ◽

Low Flow ◽

Cervical Cord ◽

Arteriovenous Fistulas ◽

Vascular Myelopathy ◽

Upper Thoracic ◽

Spinal Dural Arteriovenous Fistulas

Purpose of reviewSpinal dural arteriovenous fistulas (SDAVFs) are abnormal connections between 1 or more radiculomeningeal arteries and a single radiculomedullary vein draining into the perimedullary venous system. SDAVFs present in older patients with a progressive myelopathy caused by diffuse spinal venous hypertension. The discrepancy between the focal nature of the arteriovenous shunt and the extent of the induced myelopathy is a classic feature of SDAVFs related to the coexistence of diffuse spinal venous drainage impairment.Recent findingsWe describe 3 cases of cervical SDAVFs (at C1, C4, and C7) presenting with a myelopathy that spared the cervical spinal cord and, in 2 instances, the upper thoracic cord. This is to our knowledge the first observations of cervical SDAVFs with MRI showing absent or subtle flow voids and presenting remote thoracolumbar myelopathy without cervical cord involvement.SummaryA considerable distance may separate low-flow spinal arteriovenous fistulas from the spinal cord damage they produce. These observations emphasize the importance of performing a complete spinal angiogram when investigating a vascular myelopathy of any location and extent.

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Myelopathy due to intracranial dural arteriovenous fistula: a potential diagnostic pitfall

Journal of Neurosurgery ◽

10.3171/2010.5.jns10128 ◽

2011 ◽

Vol 114 (3) ◽

pp. 830-833 ◽

Cited By ~ 12

Author(s):

Nam-Hee Kim ◽

Keun-Tae Cho ◽

Hyung Suk Seo

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Demyelinating Disease ◽

Clinical Manifestations ◽

Transverse Myelitis ◽

Cervical Cord ◽

Diagnostic Pitfall ◽

Life Threatening ◽

Vascular Myelopathy

Intracranial dural arteriovenous fistula (DAVF) is rare and potentially life-threatening disease often presenting as vascular myelopathy. The early and proper diagnosis is challenging because the clinical manifestations are related to the distribution of the draining vein, not the fistula site, and imaging findings are similar to demyelinating disease of the spinal cord. The authors present the case of a 45-year-old man who developed acute progressive quadriplegia and respiratory difficulty with an enhancing, longitudinally extensive cervical cord lesion. These symptoms were highly suspicious for transverse myelitis but were caused by an intracranial DAVF. Intracranial DAVF with venous reflux to the brainstem and spinal cord is a rare but important differential diagnosis of progressive worsening myelopathy that is treatment resistant and gives the diagnostic impression of transverse myelitis.

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