Rupture of a Spinal Dural Arteriovenous Fistula as a Differential Diagnosis of a Coronary Syndrome: Case Report

Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spine and can lead to progressive paraplegia if left untreated. However, because of their nonspecific clinical presentation, they are often misdiagnosed as other pathologies, such as discopathies or degenerative neuropathies, which can result in delayed diagnosis and treatment.

A case of a 73-year-old female with a history of acute coronary syndrome who presented to the emergency department with sudden onset chest pain suggestive of an acute myocardial infarction is presented. Further evaluation revealed a subdural hematoma at T2-T5 and T8-L5, caused by a ruptured SDAVF at the T12-L1 level. The patient required emergency decompression surgery, but because of late diagnosis, she suffered a spinal cord injury with an ASIA-A classification.

SDAVF is a disease with nonspecific initial symptoms, which can easily be mistaken for other pathologies. However, early recognition of the presence of the fistula, especially in cases of rupture, can improve prognosis and increase the chance of better outcomes. It is important to keep this condition in mind when evaluating patients with unexplained neurological symptoms and consider SDAVF as a differential diagnosis of acute coronary syndrome.