Spinal Dural Arteriovenous Fistula-Induced Myelopathy: Rare and Commonly Missed but Treatable Nevertheless

Abstract

Objectives To highlight spinal dural arteriovenous fistula (dAVF) as a treatable cause of myelopathy that is often misdiagnosed. Clinical progression, hallmark radiological findings, and postoperative course of recovery are studied.

Patients and Methods Three patients with spinal dAVF were included in the study. Retrospective evaluation of the progression of disease and treatment received was done. Two of them were managed by surgical ligation of fistula, and the third patient was under observation because of lack of localizing symptoms.

Results Two of the three patients had previously been diagnosed with multiple sclerosis, and one of them had received steroids. The third case was easily diagnosed at an early stage as the center had become adequately sensitized about the radiologic findings. After surgical excision of the fistula, both operated cases recovered steadily but significantly, regained significant neurologic functions despite being operated at an advanced stage.

Conclusion Spinal dAVF is a rare entity. They have the potential to cause severe morbidity in the form of myelopathic changes in the cord and paraparesis in advanced stages. They can be misdiagnosed even after a magnetic resonance imaging evaluation as the appearance of dilated perimedullary veins and cord changes are not easy to interpret and require specific understanding of the radiologic changes that may occur. However, once diagnosis has been established, an early interruption of the fistula leads to a good clinical recovery.

Keywords

dural arteriovenous fistula - myelopathy - angiography - surgical excision of fistula

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