Le Goueff Anouk, Mavroudakis Nicolas, Mine Benjamin, De Witte Olivier, Remiche Gauthier
Internal Medicine Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Centre de Référence Neuromusculaire, Service de Neurologie, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Eur J Case Rep Intern Med. 2020 Jul 8;7(10):001673. doi: 10.12890/2020_001673. eCollection 2020.
Spinal dural arteriovenous fistulas (SDAVFs) are often misdiagnosed as their symptoms are non-specific, leading to treatment delay and a poor outcome. We describe the case of a 53-year-old man with a history of progressive paraparesis that worsened abruptly after an epidural corticosteroid injection. We highlight here the need for high diagnostic suspicion for an SDAVF in patients deteriorating after an epidural injection and an indication of repeated spine imaging in such cases. Finally, this is the first reported case of an SDAVF in a HIV-positive patient and it emphasizes the need for a broad differential diagnosis.
Consider an SDAVF in cases of slowly progressive paraparesis and hypoaesthesia, especially if symptoms worsen after an epidural injection.The need for an in-depth work-up including repeated angiographic explorations in cases where no malformation is found in a straightforward manner.In a patient infected with HIV, even though a broad range of neuromuscular diseases can be suspected, non-related aetiologies should not be forgotten.
脊髓硬脊膜动静脉瘘（SDAVF）常因症状不具特异性而被误诊，导致治疗延误及预后不良。我们描述了一名53岁男性的病例，该患者有进行性下肢轻瘫病史，在硬膜外注射皮质类固醇后病情突然恶化。在此我们强调，对于硬膜外注射后病情恶化的患者，需高度怀疑SDAVF，并指出在此类病例中需重复进行脊柱成像检查。最后，这是首例报告的HIV阳性患者的SDAVF病例，强调了进行广泛鉴别诊断的必要性。
对于缓慢进展的下肢轻瘫和感觉减退病例，尤其是硬膜外注射后症状加重的情况，应考虑SDAVF。在未直接发现畸形的病例中，需要进行深入检查，包括重复血管造影探查。对于感染HIV的患者，即使可怀疑多种神经肌肉疾病，但也不应忘记非相关病因。
