Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Jun 6:11:142.
doi: 10.25259/SNI_160_2020. eCollection 2020.

Spinal dural arteriovenous fistula masquerading as subdural hematoma

Kristin Huntoon  1 , Umang Khandpur  1 , David Dornbos  1 , Patrick P Youssef  1
Affiliations
Case Reports

Spinal dural arteriovenous fistula masquerading as subdural hematoma

Kristin Huntoon et al. Surg Neurol Int. .

Abstract

Background: This case highlights an angiographically occult spinal dural AVF presenting with a spinal subdural hematoma. While rare, it is important that clinicians be aware of this potential etiology of subdural hematomas before evacuation.

Case description: A 79-year-old female presented with acute lumbar pain, paraparesis, and a T10 sensory level loss. The MRI showed lower cord displacement due to curvilinear/triangular enhancement along the right side of the canal at the T12-L1 level. The lumbar MRA, craniospinal CTA, and multivessel spinal angiogram were unremarkable. A decompressive exploratory laminectomy revealed a subdural hematoma that contained blood products of different ages, and a large arterialized vein exiting near the right L1 nerve root sheath. The fistula was coagulated and sectioned. Postoperatively, the patient regained normal function.

Conclusion: Symptomatic subdural thoracolumbar hemorrhages from SDAVF are very rare. Here, we report a patient with an acute paraparesis and T10 sensory level attributed to an SDAVF and subdural hematoma. Despite negative diagnostic studies, even including spinal angiography, the patient underwent surgical intervention and successful occlusion of the SDAVF.

Keywords: Angiographically occult; Arteriovenous fistula; Subdural hematoma; Vascular malformation.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Lumbar MRI with and without contrast shows mass effect along the right side of the spinal canal from T12 to L2 levels displaces the conus leftward (a). The subcentimeter triangular focus of enhancement at T12-L1 disc can be appreciated (b). The cauda equina shows deformity inferiorly surrounded by blood products in the spinal canal. No typical evidence of flow voids consistent with increased vascularity of spinal SDAVF. Lumbar spine digital subtraction angiography (DSA) shows a contrast injection into the right L1 lumbar segmental artery (c). DSA shows the same for the left L1 lumbar segmental artery (d). There is no evidence of vascular abnormality in any phase of filling or emptying of the radicular artery and vein. Intraoperative images show a radicular artery traveling intradurally and anastomosing with the venous system, as is evident of a spinal fistula (e). Isolated view of SDAVF radicular artery (f). Temporary occlusion of the fistulous artery for extended motor and sensory monitoring for changes (g). The fistulous artery is cauterized and cut (h).
See this image and copyright information in PMC

References

    1. Cenzato M, Versari P, Righi C, Simionato F, Casali C, Giovanelli M. Spinal dural arteriovenous fistulae: Analysis of outcome in relation to pretreatment indicators. Neurosurgery. 2004;55:815–22. - PubMed
    1. Han PP, Theodore N, Porter RW, Detwiler PW, Lawton MT, Spetzler RF. Subdural hematoma from a Type I spinal arteriovenous malformation. Case report. J Neurosurg. 1999;90:255–7. - PubMed
    1. Koch C, Gottschalk S, Giese A. Dural arteriovenous fistula of the lumbar spine presenting with subarachnoid hemorrhage. Case report and review of the literature. J Neurosurg. 2004;100:385–91. - PubMed
    1. Minami M, Hanakita J, Takahashi T, Kitahama Y, Onoue S, Kino T, et al. Spinal dural arteriovenous fistula with hematomyelia caused by intraparenchymal varix of draining vein. Spine J. 2009;9:e15–9. - PubMed
    1. Spetzler RF, Detwiler PW, Riina HA, Porter RW. Modified classification of spinal cord vascular lesions. J Neurosurg. 2002;96:145–56. - PubMed

Publication types

LinkOut - more resources