[Spinal dural arteriovenous fistula: frequently diagnosed late]

The diagnosis of spinal dural arteriovenous fistula (SDAVF) is often established relatively late. In this case, we describe early clinical and radiological signs of SDAVF.

A 53-year-old patient presented with sensory deficits and disturbances related to gait, mictition and defecation. Neurological examination revealed signs of polyradiculoneuropathy. An MRI scan of the vertebral column showed swelling of the myelum and dilated perimedullary vasculature; digital subtraction angiography revealed an SDAVF. The fistula was approached surgically by hemilaminectomy after which it was successfully occluded.

An SDAVF is a connection between a radicular arteria and a radicular vein, resulting in venous hypertension and obstruction of the venous flow. Consequently, oedema forms beneath the fistula and congestive ischaemia of the myelum develops. Initial symptoms are sensory or disturbances related to gait; later, disturbances in micturition, defecation or erection may occur. Digital subtraction angiography is the gold standard. Treatment consists of surgical or endovascular occlusion of the fistula. Early recognition and treatment of SDAVF are essential for a good prognosis.