Sudden-onset paraplegia in a 72-year-old male with a spinal dural arteriovenous fistula: illustrative case

Abstract

BACKGROUND Spinal dural arteriovenous fistulas (SDAVFs) are rare vascular malformations of the spine but account for up to 80% of all vascular malformations involving the spine. Few case reports of SDAVFs have been reported in the literature, and even fewer have been described with sudden onset of symptoms. OBSERVATIONS The authors described the case of a 72-year-old male with sudden-onset bilateral paraplegia and sensory loss with subsequent inability to bear weight and an initial suspicion of cauda equina syndrome, which was eventually diagnosed as an SDAVF using magnetic resonance imaging. During open surgery, it was difficult to identify the feeder vessels. A postoperative scan showed persistence of the fistula, and the patient had to receive redo ligation with good postoperative status. LESSONS Sudden-onset paraplegia is not the typical presentation of SDAVF. All doctors need to be aware of the possibility of an acute presentation with SDAVF, especially with the high likelihood of misdiagnosis and resultant worse outcome due to treatment delays. A high index of suspicion is required to ensure early recognition as well as initiation of treatment.

A Case Report of Spinal Dural Arteriovenous Fistula: A Threatening Cause of Paraplegia

“…Treatment of SDAVF usually involves endovascular embolization (using biological glue or Onyx™) or open surgery. Embolization is typically the preferred option for extradural arteriovenous fistulas, whereas the treatment of intradural fistulae is performed via either embolization or open surgery [ 9 ]. Open surgery is more commonly preferred and offers reduced recurrence and morbidity as well as improved success rates compared with embolization.…”

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

“…A Spinal Dural Arteriovenous Fistula (SDAVF) is a rare disease that accounts for 1%-2% of vascular neurological disease [1] . It shows a male preponderance with a male: female ratio of 5:1 [2] .…”

“…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] .…”