Rapid Progression to Complete Paraplegia After Electroacupuncture in a Patient With Spinal Dural Arteriovenous Fistula: A Case Report

Abstract

Spinal dural arteriovenous fistula (SDAVF) usually has an insidious clinical course, but 5–15% of the cases have acute exacerbations. In some cases, there is an abrupt progression to paraplegia following an epidural injection or anesthesia. Electroacupuncture is a form of acupuncture that applies a small electrical current to needles inserted at specific points in the body. It is widely used for its analgesic effect on back pain. In this study, we report a rare case of SDAVF in which the symptoms of a patient worsened rapidly to complete paraplegia within a few hours after applying electroacupuncture to his back. A 49-year-old man had rapid progression to complete paraplegia within a few hours of electroacupuncture on his back. MRI showed SDAVF and worsening of cord signal change. An emergency operation was performed to ligate the SDAVF. The patient was able to walk 1 month post-operatively. Most of the neurological deficits had disappeared by 1 year post-operatively, with normalization of MRI. Our case emphasizes that SDAVF patients should be careful when exposed to any circumstances that might affect the circulation around the dural arteriovenous fistula, such as electroacupuncture. Patients should also be warned in advance about the possibility of rapid exacerbation of neurological symptoms. Regardless of the severity of the neurological symptoms, immediate treatment is essential for recovery and a better outcome.

Things are not what they seem neurologically and radiologically: An apt descriptor for spinal dural arteriovenous fistula (SDAVF)

“…This vascular fistula creates an abnormal arterialization of the venous plexus that subsequently results in venous hypertension, spinal cord edema, and eventually ischemia [3] . Commonly, patients present with chronic manifestations, however, interestingly few cases of acute presentations have been reported [ 1 , 4 ]. SDAVF is a treatable condition despite its rarity; however, the delay of diagnosis leads to unfavorable outcomes [4] .…”

“…Commonly, patients present with chronic manifestations, however, interestingly few cases of acute presentations have been reported [ 1 , 4 ]. SDAVF is a treatable condition despite its rarity; however, the delay of diagnosis leads to unfavorable outcomes [4] . The differential diagnoses are broad and the clinical presentation bears semblance to degenerative spine disease symptoms [4] .…”

“…SDAVF is a treatable condition despite its rarity; however, the delay of diagnosis leads to unfavorable outcomes [4] . The differential diagnoses are broad and the clinical presentation bears semblance to degenerative spine disease symptoms [4] . In this case report, we aim to delineate a case of SDAVF discovered after spinal decompression surgery and the persistence of symptoms thereafter.…”