Ann Rehabil Med.  2011 Dec;35(6):928-933. 10.5535/arm.2011.35.6.928.

Cauda Equina Syndrome Caused by Spinal Dural Arteriovenous Fistula

• Shin MJ
• Kim W
• Baik SK
• Kim SY
• Kim SN

• KMID: 2266820
• DOI: http://doi.org/10.5535/arm.2011.35.6.928

Abstract

Spinal dural arteriovenous fistula (SDAVF) is rare but still the most commonly encountered vascular malformation of the spinal cord. A 31-year-old male developed gait disturbance due to weakness of his lower extremities, voiding difficulty and sexual dysfunction with a progressive course since 3 months. He showed areflexia in both knees and ankles. Electromyographic findings were suggestive of multiple root lesions involving bilateral L2 to S4 roots of moderate degree. Magnetic resonance images showed high signal intensity with an ill-defined margin in T2-weighted images and intensely enhanced by a contrast agent through the lumbosacral spinal cord. Selective spinal angiography confirmed a dural arteriovenous fistula with a nidus at the L2 vertebral level. After selective endovascular embolization, his symptoms drastically improved except sexual dysfunction. We report a rare case of cauda equina syndrome due to spinal arteriovenous fistula with drastic improvement after endovascular embolization.

Keyword

Spinal dural arteriovenous fistula; Cauda equina syndrome; Endovascular embolization

MeSH Terms

Adult
Angiography
Animals
Ankle
Arteriovenous Fistula
Cauda Equina
Central Nervous System Vascular Malformations
Gait
Humans
Knee
Lower Extremity
Magnetic Resonance Spectroscopy
Male
Polyradiculopathy
Spinal Cord
Vascular Malformations

Figure

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  Fig. 1 T2-weighted magnetic resonance (MR) images (A, D) show central intramedullary hyperintensity of the distal cord and cauda equina as a sign of central myelopathy with extensive spinal cord edema. T1-weighted (B, E), pregadolinium and (C) postgadolinium MR images demonstrate intramedullary hyperintensity with flow voids (white arrow) on the dorsal aspect of the spinal cord corresponding to the dilated perimedullary veins.

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  Fig. 2 Spine anteroposterior angiogram with selective catheterization of the left L2 segmental artery (white arrow) shows a fistula draining to the perimedullary vein (black arrow) (A, B). A small sac (asterisk) is noted near the fistula which is not observed in typical dural arteriovenous fistulas (B). After embolization using a NBCA/lipiodol mixture, no further residual perfusion of the fistula was demonstrated (C, D).

• 

  Fig. 3 T2-weighted (A, D), T1-weighted (B, E), pregadolinium and (C) postgadolinium spinal MR images performed 2 weeks after endovascular embolization. Compared to previous MR images (Fig. 1), they show reduced enhancement and edema of the distal cord with diminished flow voids.

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