DOI: 10.12890/2023_003861

Spinal dural arterio-venous fistula: a vital differential diagnosis to consider for myelopathy

Authors

  • Chuen Wai Choi Department of Radiology and Organ Imaging, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
  • Chun Hong Suen Department of Radiology and Organ Imaging, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
  • Ping Yung Chu Department of Radiology and Organ Imaging, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong

choichuenwai1991@gmail.com

Keywords

Spinal dural arterio-venous fistula, Myelopathy, Spinal cord oedema, Dilated perimedullary veins, demyelinating disease

Abstract

Introduction: Spinal dural arterio-venous fistula (SDAVF) is a rare and underdiagnosed cause of myelopathy which can result in a devastating neurological outcome if not properly managed.
Case description: We report a case of SDAVF in a middle-aged man with gradual progressively deteriorating myelopathy and associated symptoms. This was first managed as demyelinating disease but was refractory to steroid therapy. Vigilant review of his spinal magnetic resonance imaging (MRI) scans showed dilated perimedullary veins, suspicious for SDAVF. The diagnosis was confirmed with catheter angiography. Neurological symptoms resolved after surgical treatment.
Discussion: SDAVF can closely mimic demyelinating conditions such as transverse myelitis or multiple sclerosis. MRI finding of dilated perimedullary veins can be subtle and masked in the late stage, posing a diagnostic challenge for physicians. It is potentially curable after timely treatment.
Conclusion: Clinicians should maintain a high level of suspicion for SDAVF and actively review all available radiological imaging for clues, particularly when there is a lack of response to treatment for other causes of myelopathy.

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References

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Published

2023-04-11

Issue

Vol. 10 No. 5 (2023)

Categories

How to Cite

1.
Choi CW, Suen CH, Chu PY. Spinal dural arterio-venous fistula: a vital differential diagnosis to consider for myelopathy. EJCRIM [Internet]. 2023 Apr. 11 [cited 2026 Nov. 3];10(5). Available from: https://ejcrim.com/index.php/ejcrim/article/view/3861