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

Abstract

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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“…Lower extremity weakness and dysuria, as well as longitudinal widespread T2 high signal on spinal MRI, have been reported in patients with low-flow PMAVFs and are easily misdiagnosed as inflammatory myelitis ( 12 , 16 ). Although there are similarities between the two, there are some clinically important clues to identify these two diseases in this article.…”

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“…The key to treating SDAVF is to eliminate the abnormal shunt, occlude the blood flow from the fistula and the venous side of the fistula, and restore normal venous drainage to the spinal cord. It is generally accepted that SDAVF should be treated as soon as it is diagnosed and that good clinical outcomes can be achieved if the patient is treated before irreversible changes in the spinal cord occur and cause dysfunction ( 22 ). Currently, the treatment methods include microsurgery, interventional embolization, or a combination of both.…”