Spinal dural arteriovenous fistula presenting with paraplegia following lumbar puncture

Case report

View More View Less
  • Department of Neurosurgery, Cliniques Universitaires St-Luc, Brussels, Belgium
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

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.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Aghakhani N, , Parker F, , David P, , Lasjaunias P, & Tadie M: Curable cause of paraplegia: spinal dural arteriovenous fistulae. Stroke 39:27562759, 2008

    • Search Google Scholar
    • Export Citation
  • 2

    Aloui-Kasbi N, , Chaker M, , Felah S, , Mattousi N, , Allani H, & Bellagha I, et al.: [Spinal vascular malformation in a child, revealed by lumbar puncture.]. Arch Pediatr 11:815818, 2004. (Fr)

    • Search Google Scholar
    • Export Citation
  • 3

    Aminoff MJ, & Logue V: The prognosis of patients with spinal vascular malformations. Brain 97:211218, 1974

  • 4

    Atkinson JL, , Miller GM, , Krauss WE, , Marsh WR, , Piepgras DG, & Atkinson PP, et al.: Clinical and radiographic features of dural arteriovenous fistula, a treatable cause of myelopathy. Mayo Clin Proc 76:11201130, 2001

    • Search Google Scholar
    • Export Citation
  • 5

    Awad IA, & Barnett GH: Neurological deterioration in a patient with a spinal arteriovenous malformation following lumbar puncture. Case report. J Neurosurg 72:650653, 1990

    • Search Google Scholar
    • Export Citation
  • 6

    Benhaiem N, , Poirier J, & Hurth M: Arteriovenous fistulae of the meninges draining into the spinal veins. A histological study of 28 cases. Acta Neuropathol 62:103111, 1983

    • Search Google Scholar
    • Export Citation
  • 7

    Burtis MT, , Ulmer JL, , Miller GA, , Barboli AC, , Koss SA, & Brown WD: Intradural spinal vein enlargement in craniospinal hypotension. AJNR Am J Neuroradiol 26:3438, 2005

    • Search Google Scholar
    • Export Citation
  • 8

    Cabrera M, , Paradas C, , Márquez C, & González A: Acute paraparesis following intravenous steroid therapy in a case of dural spinal arteriovenous fistula. J Neurol 255:14321433, 2008

    • Search Google Scholar
    • Export Citation
  • 9

    Grandin C, , Duprez T, , Stroobandt G, , Laterre EC, & Mathurin P: Spinal dural arterio-venous fistula: an underdiagnosed disease?. Acta Neurol Belg 97:1721, 1997

    • Search Google Scholar
    • Export Citation
  • 10

    Hassler W, & Thron A: Flow velocity and pressure measurements in spinal dural arteriovenous fistulas. Neurosurg Rev 17:2936, 1994

  • 11

    Hetts SW, , Narvid J, , Singh T, , Meagher S, , Corcoran K, & Higashida RT, et al.: Association between lumbar epidural injection and development of acute paraparesis in patients with spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 28:581583, 2007

    • Search Google Scholar
    • Export Citation
  • 12

    Hollis PH, , Malis LI, & Zappulla RA: Neurological deterioration after lumbar puncture below complete spinal subarachnoid block. J Neurosurg 64:253256, 1986

    • Search Google Scholar
    • Export Citation
  • 13

    Hurst RW, , Kenyon LC, , Lavi E, , Raps EC, & Marcotte P: Spinal dural arteriovenous fistula: the pathology of venous hypertensive myelopathy. Neurology 45:13091313, 1995

    • Search Google Scholar
    • Export Citation
  • 14

    Jellema K, , Canta LR, , Tijssen CC, , van Rooij WJ, , Koudstaal PJ, & van Gijn J: Spinal dural arteriovenous fistulas: clinical features in 80 patients. J Neurol Neurosurg Psychiatry 74:14381440, 2003

    • Search Google Scholar
    • Export Citation
  • 15

    Jellema K, , Tijssen CC, , Sluzewski M, , van Asbeck FW, , Koudstaal PJ, & van Gijn J: Spinal dural arteriovenous fistulas—an underdiagnosed disease. A review of patients admitted to the spinal unit of a rehabilitation center. J Neurol 253:159162, 2006

    • Search Google Scholar
    • Export Citation
  • 16

    Jellema K, , Tijssen CC, , van Rooij WJ, , Sluzewski M, , Koudstaal PJ, & Algra A, et al.: Spinal dural arteriovenous fistulas: long-term follow-up of 44 treated patients. Neurology 62:18391841, 2004

    • Search Google Scholar
    • Export Citation
  • 17

    Kataoka H, , Miyamoto S, , Nagata I, , Ueba T, & Hashimoto N: Venous congestion is a major cause of neurological deterioration in spinal arteriovenous malformations. Neurosurgery 48:12241230, 2001

    • Search Google Scholar
    • Export Citation
  • 18

    Kaut O, , Urbach H, & Klockgether T: Improvement of paraplegia caused by spinal dural arteriovenous fistula by surgical obliteration more than 6 years after symptom onset. J Neurol Neurosurg Psychiatry 79:14081409, 2008

    • Search Google Scholar
    • Export Citation
  • 19

    Kendall BE, & Logue V: Spinal epidural angiomatous malformations draining into intrathecal veins. Neuroradiology 13:181189, 1977

  • 20

    Khurana VG, , Perez-Terzic CM, , Petersen RC, & Krauss WE: Singing paraplegia: a distinctive manifestation of a spinal dural arteriovenous fistula. Neurology 58:12791281, 2002

    • Search Google Scholar
    • Export Citation
  • 21

    McCormick PC, , Torres R, , Post KD, & Stein BM: Intramedullary ependymoma of the spinal cord. J Neurosurg 72:523532, 1990

  • 22

    Mokri B: The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology 56:17461748, 2001

  • 23

    Narvid J, , Hetts SW, , Larsen D, , Neuhaus J, , Singh TP, & McSwain H, et al.: Spinal dural arteriovenous fistulae: clinical features and long-term results. Neurosurgery 62:159167, 2008

    • Search Google Scholar
    • Export Citation
  • 24

    Oldfield EH, , Di Chiro G, , Quindlen EA, , Rieth KG, & Doppman JL: Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula. J Neurosurg 59:10191030, 1983

    • Search Google Scholar
    • Export Citation
  • 25

    Oliver TA, , Sorensen M, & Arthur AS: Endovascular treatment for acute paraplegia after epidural steroid injection in a patient with spinal dural arteriovenous malformation. Case report. J Neurosurg Spine 17:251255, 2012

    • Search Google Scholar
    • Export Citation
  • 26

    Rosenblum B, , Oldfield EH, , Doppman JL, & Di Chiro G: Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM's in 81 patients. J Neurosurg 67:795802, 1987

    • Search Google Scholar
    • Export Citation
  • 27

    Roullet E, , Netter JM, , Chiras J, , Mahieux F, , Amarenco P, & Marteau R: [Spinal dural arteriovenous fistulae: exacerbation after myelography with metrizamide.]. Rev Neurol (Paris) 144:371375, 1988. (Fr)

    • Search Google Scholar
    • Export Citation
  • 28

    Rousset J, , Lapierre M, , André V, , Bellard S, & Garcia JF: [Dilatation of cervical epidural veins secondary to iatrogenic intracranial hypotension.]. J Radiol 90:6971, 2009. (Fr)

    • Search Google Scholar
    • Export Citation
  • 29

    Sghirlanzoni A, , Gemma M, , Pareyson D, , Cimino C, & Boiardi A: Spinal arteriovenous fistula. A possible cause of paraparesis after epidural anaesthesia. Anaesthesia 44:831833, 1989

    • Search Google Scholar
    • Export Citation
  • 30

    Sinclair AJ, , Carroll C, & Davies B: Cauda equina syndrome following a lumbar puncture. J Clin Neurosci 16:714716, 2009

  • 31

    Söderlund ME, , Benisty S, , Gaston A, , Djindjian M, , Cesaro P, & Créange A: [Can myelopathies secondary to arterio-venous dural fistulae be aggravated by intravenous corticosteroid therapy?]. Rev Neurol (Paris) 163:235237, 2007. (Fr)

    • Search Google Scholar
    • Export Citation
  • 32

    Strowd RE, , Geer C, , Powers A, & Abou-Zeid N: A unique presentation of a spinal dural arteriovenous fistula exacerbated by steroids. J Clin Neurosci 19:466468, 2012

    • Search Google Scholar
    • Export Citation
  • 33

    Thron A: [Spinal dural arteriovenous fistulas.]. Radiologe 41:955960, 2001. (Ger)

Metrics

All Time Past Year Past 30 Days
Abstract Views 671 152 11
Full Text Views 157 22 4
PDF Downloads 170 16 5
EPUB Downloads 0 0 0