Atypical spinal cord injury: spinal dural arteriovenous fistula.

Spinal dural arteriovenous fistulas (SDAVF) are vascular anomalies composed of intertwining arteries and veins with direct arteriovenous (AV) communication. It is presumed that the fistula is an acquired abnormality that produces an arterialization and increase in venous blood flow leading to venous hypertension, venous congestion with eventual hypo-perfusion, or ischemia of the spinal cord. Symptoms include progressive sensory and motor changes that commonly take place over a 2- to 3-year time span. Exacerbation of symptoms is frequently the reason for additional diagnostic work-up. Treatment is aimed at elimination of the communication between arteries and veins. Treatment options include surgical resection of the piece of dura containing the AV fistula, transvascular embolization, or a combined procedure. Outcome is a function of the extent of cord injury and full recovery is rare. Rehabilitation is crucial in maximizing functional outcomes. It is essential for the nurse caring for the patient with a SDAVF to understand the pathological changes related to the fistula, correlate clinical findings, identify diagnostic tools for evaluation, and differentiate treatment options. An understanding of the disorder will provide the groundwork for the nurse to formulate a plan of care identifying patient needs from assessment parameters, rehabilitation needs, and patient education.