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Título

Dural arteriovenous fistula as a cause of myelopathy

RESUMO

CASE PRESENTATION: A 52-year-old male patient, without comorbidities, presented crural motor deficits with insidious onset about 2 years ago. He had had a car accident one month before the onset of the alterations. Upon admission, the patient presented crural paraparesis, grade III to the left and grade IV to the right, associated with elastic hypertonia and exalted patellar and Achilles reflexes. Spinal resonance imaging showed increased volume with diffuse intramedullary hypersignal at T2/STIR, associated with serpinous congestive dilatation of the intradural pial veins surrounding the thoracic medullary cord, predominantly from the level of D6 to D12, including a lesser degree of edema of the medullary cone, suggestive of venous congestive myelopathy secondary to dural spinal arteriovenous fistula (DASF). Subsequently, a spinal cord angiography was performed, which confirmed the dorsal DASF at the level of the left D8 type 1 intervertebral foramen, and its embolization with adhesive embolic fluid. Anatomical occlusion of the dural arteriovenous malformation was obtained.
DISCUSSION: Spinal vascular malformations may be arterial or venous, corresponding to rare lesions, with an incidence of approximately 4% of spinal cord masses. They constitute a quite heterogeneous group, the main lesions being arteriovenous malformations (AVMs), DASF, spinal hemangiomas, cavernous angiomas and aneurysms. DASF is the most common (70%), being a direct communication between a radiculomingeal artery directly feeding a radicular vein; it causes venous congestion due to increased pressure in the venous system and constitutes a low-flow lesion. They are much more common in men than in women and occur mainly between the fifth and eighth decade of life, with the thoracolumbar region being the most affected.
Bnb FINAL COMMENTS: DASF is a rare cause of myelopathy but potentially treatable if diagnosed early. A case was shown that due to the prolonged time between the onset of symptoms and adequate treatment the patient had little clinical response.

Palavras Chave

dural spinal arteriovenous fistula; myelopathy; arteriovenous malformations

Área

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