Alhendawy Ibrahem, Homapour Bob, Chandra Ronil V, Drnda Armin
Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, 3168, Australia.
Department of Interventional Neuroradiology, Monash Medical Centre, Clayton, Victoria, 3168, Australia.
Int J Surg Case Rep. 2021 Apr;81:105797. doi: 10.1016/j.ijscr.2021.105797. Epub 2021 Mar 19.
Spinal dural arteriovenous fistula (SDAVF) is an uncommon cause of longitudinal extensive transverse myelitis (LETM). It usually presents with vague congestive myelopathy symptoms and diagnosis is usually difficult on initial presentation. Common daily neurological interventions can aggravate the underlying pathophysiology leading to undesirable acute neurological deterioration. Intravenous steroids administration and lumbar (LP) puncture as a diagnostic tool are amongst the most commonly reported aggravating interventions. This rare case presentation highlights this association with its negative impact on the patient outcome in misdiagnosed cases.
The authors present a sixty-eight-year-old male with paraplegia following steroid administration and LP for presumed inflammatory/autoimmune LETM in the setting of misdiagnosed SDAVF. The absence of flow voids on the conventional T2-weighted magnetic resonance image (MRI) lead to misdiagnosis. He had satisfactory neurological recovery few hours after surgical disconnection.
SDAVF is known to cause congestive myelopathy symptoms. Spinal angiogram is the gold standard for diagnosis. Although the exact mechanism is not fully understood, misdiagnosed cases like our case can develop severe neurological deterioration with steroid administration and lumbar puncture.
Although SDAVF is an uncommon cause of LETM, Clinicians should carefully exclude it before proceeding to steroid administration or performing LP as they can lead to devastating neurological deterioration.
脊髓硬脊膜动静脉瘘（SDAVF）是纵向广泛横贯性脊髓炎（LETM）的一种罕见病因。它通常表现为模糊的充血性脊髓病症状，初次就诊时通常难以诊断。日常常见的神经干预措施可能会加重潜在的病理生理过程，导致不良的急性神经功能恶化。静脉注射类固醇和腰椎穿刺作为诊断工具是最常报告的加重病情的干预措施。这个罕见的病例报告突出了这种关联及其对误诊病例患者预后的负面影响。
作者报告了一名68岁男性，在因误诊为SDAVF而疑似炎症/自身免疫性LETM接受类固醇治疗和腰椎穿刺后出现截瘫。常规T2加权磁共振成像（MRI）上没有流空信号导致了误诊。手术切断瘘管几小时后，他的神经功能恢复良好。
已知SDAVF会引起充血性脊髓病症状。脊髓血管造影是诊断的金标准。尽管确切机制尚未完全了解，但像我们这个病例这样的误诊病例在使用类固醇和腰椎穿刺后可能会出现严重的神经功能恶化。
尽管SDAVF是LETM的罕见病因，但临床医生在进行类固醇治疗或腰椎穿刺之前应仔细排除该病因，因为它们可能导致毁灭性的神经功能恶化。
