A rare cause of radiculomyelitis: dural arteriovenous fistula
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Published on: September 13, 2022
Ahmet K Kilic1, Asli T Kurne2, Isil Saatci3
1Graduate School of Health Sciences, Medical School of Hacettepe University, Ankara, Turkey.
Importance:
Dural arteriovenous fistula is a very rare cause of myelitis that can only be treated interventionally or surgically.
Observations:
A man in his 30s with paraparesis and urinary incontinence had a long-segment thoracic lesion on spinal magnetic resonance imaging. Transverse myelitis was the initial diagnosis. Although a pulse steroid and intravenous immunoglobulin treatment regimen was given, no definite clinical response was seen. A spinal angiogram was performed in our center demonstrating right T7 to T8 spinal dural arteriovenous fistula. The fistula was occluded with embolization and the patient showed recovery following the endovascular treatment.
Conclusions And Relevance:
Myelitis usually is known to respond well to immunosuppressive treatments. Despite adequate medical treatment, if slow progression is seen in the follow-up clinically and radiologically, dural arteriovenous fistulas should be kept in mind in the etiopathogenesis.
Insights
Spinal dural arteriovenous fistulas are rare causes of myelitis. Endovascular embolization of a T7-T8 fistula led to recovery in a patient unresponsive to standard treatments.
Area of Science:
- Neurology
- Interventional Radiology
- Neurosurgery
Background:
- Dural arteriovenous fistulas are uncommon causes of myelitis.
- Myelitis typically responds to immunosuppressive therapies.
Observation:
- A patient with initial diagnosis of transverse myelitis showed no improvement with pulse steroids and intravenous immunoglobulin.
- Spinal magnetic resonance imaging revealed a long-segment thoracic lesion.
- A spinal angiogram identified a T7-T8 spinal dural arteriovenous fistula.
Findings:
- Endovascular embolization successfully occluded the identified dural arteriovenous fistula.
- The patient experienced clinical recovery following the endovascular treatment.
Implications:
- Dural arteriovenous fistulas should be considered in the differential diagnosis of myelitis, especially when standard treatments fail.
- Early identification and endovascular intervention can lead to favorable outcomes in patients with dural arteriovenous fistula-induced myelitis.
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