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Spinal dural arteriovenous fistula

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Brought to you by the Residents & Fellows Section of Neurology.

April 8, 2015

Spinal dural arteriovenous fistula

Spinal dural arteriovenous fistula is the most common vascular abnormality in the spinal cord. Although the presentation can be variable, most patients develop progressive gait imbalance with associated ascending lower extremity weakness, numbness, paresthesias, low back pain, and eventually bowel and bladder dysfunction. Valsalva maneuvers that increase the central venous pressure, such as coughing, sneezing or exercising, often leads to a paroxysmal worsening of patient’s symptoms. Interestingly, one case report has described an opera singer whose paraparesis worsened during performances. On imaging, a contrasted MRI shows increased signal intensity in the central cord on T2 images and/or numerous flow-voids along the dorsal cord, representing dilated veins. After embolization or ligation of the offending artery, many patients have stabilization or improvement in gait and strength, but pain and bowel and bladder dysfunction are usually unchanged.

References

  1. Jellema K, Canta LR, Tijssen CC, van Rooij WJ, Koudstaal PJ, van Gijn J. Spinal dural arteriovenous fistulas: clinical features in 80 patients. Journal of Neurosurgery Psychiatry 2003; 74: 1438-1440.
  2. Luetmer PH, Lane JI, Gilbertson JR, Bernstein MA, Huston III J, Atkinson JLD. Preangiographic Evaluation of Spinal Dural Arteriovenous Fistulas with Elliptic Centric Contrast-Enhanced MR Angiography and Effect on Radiation Dose and Volume of Iodinated Contrast Material. American Journal of Neuroradiology 2005; 26: 711-718.
  3. Jellema K, Tijssen CC, van Rooij WJJ, et al. Spinal dural arteriovenous fistulas: Long-term follow-up of 44 treated patients. Neurology 2004; 62:1839-1841.

Submitted by James Addington, MD, and Kathryn Nevel, MD, Department of Neurology, University of Virginia.

Dr. Addington is a member of the Residents & Fellows Section of Neurology. Dr. Nevel reports no disclosures.

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