Unusual manifestation of the spinal epidural arteriovenous fistula as sudden paraplegia

Background: Spinal epidural arteriovenous fistulas (SEDAVFs) are a rare disease that cause the gradual progression of neurological dysfunction. We herein document the case of SEDAVF with acute exacerbation of paraplegia that was successfully treated with emergency trans-arterial embolization (TAE).

Case description: A 73-year-old male patient presented with low back pain, numbness in the lower extremities, and gait disturbance. Radiological examination revealed edema of the thoracolumbar spinal cord on T2-weighted magnetic resonance imaging. Moreover, computed tomography angiography (CTA) demonstrated that the SEDAVF was fed by an expanded left first lumbar artery, epidural venous plexus at the left L1/2 intervertebral foramen, and intradural venous drainage. The patient suddenly developed severe paraplegia 2 days later. We performed emergency spinal angiography followed by TAE. The postoperative course was uneventful, and his preoperative symptoms improved.

Conclusion: SEDAVFs may result in acute exacerbation that can be treated with an endovascular intervention: a rapid and effective means of obliterating shunts.

Keywords: Endovascular treatment; Spinal epidural arteriovenous fistula; sudden paraplegia.