Journal of Emergencies, Trauma, and Shock
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PICTORIAL EDUCATION  
Year : 2011  |  Volume : 4  |  Issue : 2  |  Page : 299
Spinal dural arteriovenous fistula incidentally discovered


1 Harvard School of Public Health, MA, USA
2 Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Mito, Japan
3 Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
4 Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA

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Date of Submission30-Nov-2010
Date of Acceptance24-Dec-2010
Date of Web Publication18-Jun-2011
 

How to cite this article:
Abe T, Tokuda Y, Ishimatsu S, Stein GH. Spinal dural arteriovenous fistula incidentally discovered. J Emerg Trauma Shock 2011;4:299

How to cite this URL:
Abe T, Tokuda Y, Ishimatsu S, Stein GH. Spinal dural arteriovenous fistula incidentally discovered. J Emerg Trauma Shock [serial online] 2011 [cited 2019 Dec 15];4:299. Available from: http://www.onlinejets.org/text.asp?2011/4/2/299/82227


A 66-year-old man, with a history of sick sinus syndrome with pacemaker implantation 11 years ago, developed an abrupt-onset seizure and lost consciousness for a few minutes. On physical examination, he was alert with normal vital signs. He complained of neuralgia at C3-4 levels. No motor weakness or sensory disturbances were identified. There was no pacemaker failure, no acute coronary syndrome or no subarachnoid hemorrhage. Cervical spine CT myelography showed mass lesion compressing C1-2 spinal cord [Figure 1]. Three-dimensional neck CT angiography also indicated spinal dural arteriovenous fistula (SDAVF) around the  Atlas More Details-occipital bone articulation [Figure 2]. After a few days of watchful waiting without using steroids, his pain symptoms completely resolved. Three weeks later, endovascular embolization was carried out. The patient has had no recurrence after 1 year.
Figure 1: CT myelography showing a spinal dural mass lesion compressing (4 mm size) the spinal canal in the left posterior side at C1-2 levels

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Figure 2: Three-dimensional cervical CT angiography showing angiomegaly in the area of left atlas-occipital bone articulation

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SDAVF myelopathy is irreversible. [1] Although congestion of SDAVF may mimic peripheral neuropathy, we mainly diagnosed his numbness as the muscular stresses from the seizure because of quick recovery. Recently, we incidentally encountered the patients with SDAVF because of advanced imaging. Emergency physician should know the courses of SDAVF.

 
   References Top

1.Koch C. Spinal dural arteriovenous fistula. Curr Opin Neurol 2006;19:69-75.  Back to cited text no. 1
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Correspondence Address:
Toshikazu Abe
Harvard School of Public Health, MA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.82227

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