A dural arteriovenous fistula masquerading as myelitis- A case report

Brain disorders (Amsterdam, Netherlands) Pub Date : 2025-05-30 DOI:10.1016/j.dscb.2025.100243

Tanushree Chawla , Anshu Mahajan , Gaurav Goel , Vinay Goyal

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Abstract

Introduction

Intracranial dural Arteriovenous Fistulas (dAVFs) are rare vascular malformations with diverse clinical manifestations due to ischemia secondary to venous congestion or haemorrhage. Our case clinically and radiologically closely mimicked myelitis.

Case

We present a 58-year-old male with quadriparesis and bulbar involvement mimicking myelitis on MRI, not responding to the initial treatment with Intravenous Methylprednisolone (IVMPS) and Intravenous Immunoglobulin (IVIg). On subsequent visit to our center, repeat scanning revealed serpentine flow voids on the anterior surface of the cord. Digital Substraction Angiography (DSA) revealed a posterior fossa dAVF which was successfully obliterated with embolization leading to marked symptomatic improvement.

Conclusion

A high degree of suspicion is required when imaging suggestive of myelitis doesnot respond to immunomodulatory therapy. Imaging appearance of serpentine flow voids shall be closely looked for in all cases with myelitis.

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伪装成脊髓炎的硬膜动静脉瘘1例报告

颅内硬脑膜动静脉瘘（dAVFs）是一种罕见的血管畸形，临床表现多样，是由静脉充血或出血引起的缺血所致。我们的病例在临床和放射学上与脊髓炎非常相似。病例：我们报告了一名58岁男性四肢瘫和球受累的MRI模拟脊髓炎，最初静脉注射甲基强的松龙（IVMPS）和静脉注射免疫球蛋白（IVIg）治疗无效。在随后的访问我们中心时，重复扫描显示脊髓前表面有蛇形血流空洞。数字减影血管造影（DSA）显示后颅窝dAVF，栓塞成功消除，导致症状明显改善。结论当影像学提示脊髓炎对免疫调节治疗无效时，应高度怀疑。在所有脊髓炎病例中，应密切观察蛇形流腔的影像学表现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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