Fact-sheet: Arteriovenous fistula of spinal cord
Updated on 04/23/2019 at 9:06 AM
View all RADEOS cases associated with this fact-sheet
Definition
Single shunt between an epidural artery, most often a radiculomeningeal artery, and an epidural and/or perimedullary vein that drains retrograde, resulting in increased perimedullary venous pressure, leading to spinal cord venous congestion and impaired tissue perfusion with chronic ischemic injury and cord edema
Most common spinal vascular malformations
Clinical features
Delayed diagnosis
Male predominance, between 55 and 60 years of age.
Nonspecific clinical presentation:
- Subjective or objective sensory disturbances
- Radicular pain
- Motor deficits with difficulty climbing stairs.
- Late sphincter dysfunction
Laboratory findings
Absolute contraindication to lumbar puncture!
MRI
- Centromedullary edema, T2 hyperintense
- Increased spinal cord volume
- Dilated, serpiginous perimedullary vessels, T2 flow-void, with contrast enhancement after injection
- +/- spinal cord enhancement due to chronic ischemic injury
- Diffusion hyperintensity with decreased ADC
Vascular intervention
Confirms the arteriovenous shunt with perimedullary venous drainage
Localizes the feeding artery
Plans the therapeutic strategy: occlusion of the shunt and the origin of the draining vein, via endovascular or surgical approach
Differential diagnosis
Arteriovenous malformation of spinal cord, characterized by the presence of a nidus
