Acute paraplegia in patient with spinal dural arteriovenous fistula after lumbar puncture and steroid administration: A case report

Alhendawy, Ibrahem; Homapour, Bob; Chandra, Ronil V.; Drnda, A.

doi:10.1016/j.ijscr.2021.105797

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…SDAVF has an acute onset with acute spinal nerve dysfunction, and when MRI only shows signs of spinal edema, it can easily be misdiagnosed as acute myelitis ( 24 ). Acute myelitis is a transverse spinal cord injury caused by a series of immune responses due to various factors.…”

Section: Discussionmentioning

confidence: 99%

Imaging characteristics, misdiagnosis and microsurgical outcomes of patients with spinal dural arteriovenous fistula: a retrospective study of 32 patients

Zhang¹,

Zhai²,

Li³

et al. 2022

Ann Transl Med

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Background Spinal dural arteriovenous fistula (SDAVF) is an extremely rare spinal vascular malformation. As SDAVF exhibits no specific clinical manifestations nor diverse imaging results, it is easily misdiagnosed, resulting in delayed treatment and irreversible neurological damage. Most patients were initially misdiagnosed, but there were few reports on reducing misdiagnosis. Methods A total of 32 consecutive patients, who presented to our institution (Shanghai Deji Hospital) with SDAVF between June 2013 and January 2016 were retrospectively analyzed. Data were collected on demographics, clinical presentation, imaging findings, follow-up, and clinical outcomes. The Aminoff-Logue scale (ALS) was used to assess clinical outcomes. Results Of the 32 enrolled patients (3 females, mean age 59.1±3.8 years), 23 patients (71.9%) were misdiagnosed as acute myelitis (11 patients), intramedullary tumors (6 patients), lumbar disc herniation (4 patients), and other conditions (2 patients). All patients underwent surgical procedures under electrophysiological monitoring. Fistulas were found in all 32 patients and were successfully occluded. The mean follow-up period was 19.22±8.21 months (ranging from 2 weeks to 30 months). One year later, 20 patients underwent magnetic resonance imaging (MRI), and 14 showed no T2 edema, and the edema was relieved in 6 patients. A total of 10 patients underwent enhancement MRI and no enhancement signs were detected. Among the 27 patients with long-time follow-up, the fistula had no residual or recurrence, 21 patients showed decreased ALS scores (P<0.05). Six patients exhibited nonsignificant improvement. No aggravating patient was found. Prognosis differed significantly between patients with ALS <6 and those with ALS ≥6 (P<0.05). Conclusions Spinal angiography should be performed with full intubation, and microcatheter angiography can reduce misdiagnosis. SDAVF must be differentiated from acute myelitis, intramedullary tumor, and other spinal vascular malformations. Microsurgical treatment is effective with a low recurrence rate.

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Section: Discussionmentioning

confidence: 99%

Imaging characteristics, misdiagnosis and microsurgical outcomes of patients with spinal dural arteriovenous fistula: a retrospective study of 32 patients

Zhang¹,

Zhai²,

Li³

et al. 2022

Ann Transl Med

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“…Spinal dural arteriovenous fistula (SDAVF) is a rare cause of transverse myelitis. In cases of SDAVF-induced transverse myelitis, symptoms may be exacerbated by steroid treatment and lumbar puncture [13,14]. We diagnosed VZV-induced ATM with a history of VZV infection and myelopathy at a level similar to that of the dermatome, where the zoster was present.…”

Section: A a B Bmentioning

confidence: 99%

Acute Transverse Myelitis after Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case Report

Yoo

Kim

Park

et al. 2022

J Electrodiagn Neuromuscul Dis

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Herpes zoster is caused by reactivated varicella-zoster virus (VZV) and characterized by a painful skin rash with vesicles that affects the adjacent dermatomes. Transverse myelitis is a rare complication of VZV infection that may even occur in immunocompetent patients. Here, we report a 60-year-old male patient admitted with right lower-extremity weakness and hypesthesia. Spine magnetic resonance imaging (MRI) revealed transverse myelitis at the C3–C4 and T6 levels. A month prior to admission, the patient was diagnosed with herpes zoster involving the right T2-T4 dermatome. Considering his history of VZV infection, he was treated with intravenous steroids and acyclovir. Eleven days after hospitalization, paraplegia developed to Medical Research Council grade 0/5 despite performing plasmapheresis. MRI confirmed the aggravation of the cord lesion between T4 and T7. Acute transverse myelitis after VZV infection is a rare disease that can cause serious sequelae in immunocompetent patients. Therefore, clinicians should be cautious of this situation.

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“…Spinal dural arteriovenous fistula (SDAVF) is a rare type of spinal cord vascular malformation and often clinically manifests as progressive congestive myelopathy ( 1 ). The main pathogenic mechanism is the abnormal communication between the spinal root artery and the spinal drainage vein, resulting in a fistula, venous hypertension, stagnant blood flow, edema and necrosis of the spinal cord neuronal cells, and progressive ischemic and hypoxic myelopathy ( 2 , 3 ). SDAVF is insidious and has a low incidence rate, an atypical clinical presentation, and an insensitivity to conventional imaging; moreover, magnetic resonance imaging (MRI) is required for screening, while spinal angiography is required for a definitive diagnosis ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

A very rare complication after knee arthroplasty: a case description of postoperative acute paraplegia

Li¹,

Wang²,

Fan³

et al. 2023

Quant Imaging Med Surg

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Acute paraplegia in patient with spinal dural arteriovenous fistula after lumbar puncture and steroid administration: A case report

Cited by 6 publications

References 16 publications

Imaging characteristics, misdiagnosis and microsurgical outcomes of patients with spinal dural arteriovenous fistula: a retrospective study of 32 patients

Imaging characteristics, misdiagnosis and microsurgical outcomes of patients with spinal dural arteriovenous fistula: a retrospective study of 32 patients

Acute Transverse Myelitis after Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case Report

A very rare complication after knee arthroplasty: a case description of postoperative acute paraplegia

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