Spinal dural arteriovenous fistula presenting with paraplegia following lumbar puncture

Case report

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Spinal dural arteriovenous fistulas are rare lesions with an annual incidence of 1 per 100,000 population. In patients with this disease, an abnormal vascular dural shunt exists between a dural branch of a segmental artery and a subdural radicular vein that drains the perimedullary venous system, leading to venous hypertension and secondary congestive myelopathy. Generally, patients present with progressive paraparesis, urinary disturbances, and gait ataxia. In this report the authors describe a 61-year-old woman with a spinal dural arteriovenous fistula who developed an acute paraplegia after a nontraumatic lumbar puncture. The possible underlying mechanisms and treatment options are discussed.

Abbreviations used in this paper:AVF = arteriovenous fistula; LP = lumbar puncture; MRC = Medical Research Council; SDAVF = spinal dural AVF.

Article Information

Address correspondence to: Guus Koerts, M.D., Department of Neurosurgery, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, Brussels 1200, Belgium. email: guus.koerts@uclouvain.be.

Please include this information when citing this paper: published online May 3, 2013; DOI: 10.3171/2013.3.SPINE12888.

© AANS, except where prohibited by US copyright law.

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    Sagittal T1-weighted MR image of the dorsolumbar spine showing intramedullary pencil-like hypersignal (arrowhead) and dilated perimedullary veins (arrow).

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    Superselective spinal angiogram of the second lumbar artery. Left: Early phase with immediate opacification of the tortuous arterialized vein (white arrows in both panels). Right: Later phase with opacification of the radicular artery (black arrows in both panels).

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