Rare Case of Spinal Dural Arteriovenous Fistula with Radiculopathy, without Myelopathy or Spinal Edema on Magnetic Resonance Imaging

Oki, Sogo; Osanai, Toshiya; Tokairin, Kikutaro; Takamiya, Soichiro; Yamazaki, Kazuyoshi; Imai, Tetsuaki; Seki, Takahiro

doi:10.1016/j.wneu.2020.03.138

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…Arterialization of radicular veins increases hydrostatic pressure within local venous plexuses resulting in cord edema. Direct compression from dilated veins may also result in cord/root compression [ 3 , 4 ]. The majority of SDAVF are thoracolumbar and extend through multiple spinal segments, with venous dilation spanning a mean of 10 ± 7.7 levels [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report

et al. 2023

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Background Gadolinium enhancement of spinal nerve roots on magnetic resonance imaging (MRI) has rarely been reported in spinal dural arteriovenous fistula (SDAVF). Nerve root enhancement and cerebrospinal fluid (CSF) pleocytosis can be deceptive and lead to a misdiagnosis of myeloradiculitis. We report a patient who was initially diagnosed with neurosarcoid myeloradiculitis due to spinal nerve root enhancement, mildly inflammatory cerebrospinal fluid, and pulmonary granulomas, who ultimately was found to have an extensive symptomatic SDAVF. Case presentation A 52-year-old woman presented with a longitudinally extensive spinal cord lesion with associated gadolinium enhancement of the cord and cauda equina nerve roots, and mild lymphocytic pleocytosis. Pulmonary lymph node biopsy revealed non-caseating granulomas and neurosarcoid myeloradiculitis was suspected. She had rapid and profound clinical deterioration after a single dose of steroids. Further work-up with spinal angiography revealed a thoracic SDAVF, which was surgically ligated leading to clinical improvement. Conclusions This case highlights an unexpected presentation of SDAVF with nerve root enhancement and concurrent pulmonary non-caseating granulomas, leading to an initial misdiagnosis with neurosarcoidosis. Nerve root enhancement has only rarely been described in cases of SDAVF; however, as this case highlights, it is an important consideration in the differential diagnosis of non-inflammatory causes of longitudinally extensive myeloradiculopathy with nerve root enhancement. This point is highly salient due to the importance of avoiding misdiagnosis of SDAVF, as interventions such as steroids or epidural injections used to treat inflammatory or infiltrative mimics may worsen symptoms in SDAVF. We review the presentation, diagnosis, and management of SDAVF as well as a proposed diagnostic approach to differentiating SDAVF from inflammatory myeloradiculitis.

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Section: Discussionmentioning

confidence: 99%

Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report

et al. 2023

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“…In our research, 19 patients (86%) had an area of T2 high signal intensity and flow void in the spinal cord, and the statistics are consistent with literature ( 18 , 21 , 23 ). There are also very few patients who do not have the above typical findings on MRI ( 24 ). As we demonstrated in case 2, there were no typical signs of spinal cord edema or vessel flow voids on the spinal cord on MRI.…”

Section: Discussionmentioning

confidence: 99%

Spinal dural arteriovenous fistula: A rare but treatable disease that should not be missed by orthopedic surgeons

Yang

et al. 2022

Front. Neurol.

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ObjectiveSpinal dural arteriovenous fistula (SDAVF) is a rare disease that is often misdiagnosed by orthopedic surgeons. We analyzed the reasons for the misdiagnosis and proposed countermeasures.MethodsTwenty-two SDAVF patients who were initially treated in orthopedics were included. The patients were divided into a correct diagnosis group (A) and a misdiagnosis group (B). The clinical data and prognosis were evaluated.ResultsThere were 10 patients in group A and 12 patients in group B. The clinical manifestations included limb numbness, weakness, and bladder and bowel dysfunction. Among these patients without spinal degenerative diseases which had typical magnetic resonance imaging (MRI) features in Group A were more than Group B (P < 0.05). More patients had spinal degenerative diseases in group B. In group A, seven patients were primarily diagnosed with a SDAVF after multidisciplinary teamwork (MDT). In group B, five patients were misdiagnosed with lumbar spinal stenosis, four with lumbar disc herniation, two with thoracic spinal stenosis, and one with cervical spinal stenosis and lumbar spinal stenosis and underwent cervical spinal canal and lumbar spinal canal decompression. The length of time for confirming the diagnosis was 7 months longer in group B than in group A. All patients underwent microsurgery treatment. The average follow-up duration was 11 months. The modified Aminoff-Logue Disability Scale scores showed a statistically significant difference in improvement between the two groups (P < 0.05).Conclusionwhen patients with dysuria especially, have intermittent spinal nerve dysfunction, the possibility of SDAVF should be considered. Awareness of the specific clinical and spinal cord edema and flow voids on MRI of a SDAVF needs to be promoted for orthopedic surgeons. Timely MDT is an important measure for reducing misdiagnosis, and steroids or inappropriate surgery should be avoided until a SDAVF is completely excluded.

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“…According to the Spetzler classification [6], SDAVFs are of low flow, causing venous congestion in the most caudal regions of the spinal cord. However, mechanisms of vascular compression have also been proposed as the cause of some radicular syndromes [2].…”

Section: Discussionmentioning

confidence: 99%

“…An important symptom is a lumbar or radicular pain that has been described in more than half of the cases of SDAVF [4,5] and places it within the differential diagnosis of painful myelopathy along with other demyelinating diseases. By encompassing symptoms in clinical syndromes, SDAVF frequently presents as a radicular, medullary cone, or epicone syndrome [2][3][4]. Therefore, when faced with these syndromes, this entity should always be considered.…”

Section: Discussionmentioning

confidence: 99%

“…SDAVF is an abnormal connection between a radicular artery and a radicular vein leading to venous congestion, causing nonspecific motor and sensory symptoms that mimic radiculopathies and other entities such as demyelinating or degenerative diseases of the spine, which makes it a condition difficult to diagnose. A careful neurological examination is important since early recognition and timely treatment of SDAVF are essential for a good prognosis [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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Spinal Dural Arteriovenous Fistula: A Mimic of Demyelinating Disease and Radiculopathy

Alfaro-Olivera¹,

Otiniano-Sifuentes²,

Simbrón-Ribbeck³

et al. 2022

Cureus

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Spinal dural arteriovenous fistula (SDAVF) is characterized by an abnormal connection between a radicular artery and the venous plexus producing spinal cord venous congestion. It manifests with nonspecific sensory and motor symptoms. We present three cases of SDAVF with different forms of presentation; in two cases, an autoimmune etiology was considered, and in the third case, the initial diagnosis was chronic radiculopathy. In all three cases, a serpentine enhancement was observed after the gadolinium in the dorsal region of the spinal cord corresponded to flow voids in T2-weighted images, which guided the diagnosis. SDAVF should be considered in atypical clinical presentations of radiculopathies or spinal cord syndromes, especially spinal conus or epicone syndrome. Likewise, it should be part of the differential diagnosis of spinal cord presentations of demyelinating diseases such as multiple sclerosis or neuromyelitis optica spectrum disorders.

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Rare Case of Spinal Dural Arteriovenous Fistula with Radiculopathy, without Myelopathy or Spinal Edema on Magnetic Resonance Imaging

Cited by 6 publications

References 7 publications

Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report

Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report

Spinal dural arteriovenous fistula: A rare but treatable disease that should not be missed by orthopedic surgeons

Spinal Dural Arteriovenous Fistula: A Mimic of Demyelinating Disease and Radiculopathy

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