Unusual Manifestation of Spinal Epidural Arteriovenous Fistula as Sudden Paraplegia.

Abstract

Spinal epidural arteriovenous fistulas (SEDAVFs) are a rare entity that cause gradual progression of neurological dysfunction. We present a case of SEDAVF with acute exacerbation of paraplegia that was successfully treated with emergency transarterial embolization. A 73-year-old man presented with low back pain, numbness in the lower extremities, and gait disturbance. T2-weighted magnetic resonance imaging revealed edema of the thoracolumbar spinal cord. Computed tomography angiography showed that the SEDAVF was fed by an expanded left L1 artery, epidural venous plexus at the left L1-2 intervertebral foramen, and intradural venous drainage. The patient suddenly developed severe paraplegia 2 days later. We performed emergency spinal angiography followed by transarterial embolization. The postoperative course was uneventful, and his preoperative symptoms improved. SEDAVFs may result in acute exacerbation that can be treated with an endovascular intervention-a rapid and effective means of obliterating shunts.