We describe a man with an intracranial dural arteriovenous fistula that presented as a subacute longitudinally extensive cervical myelopathy. The uncommon location of the fistula and the absence of specific radiological signs resulted in initial misdiagnosis as longitudinally extensive transverse myelitis. Neurologists should have a high index of suspicion for dural arteriovenous fistula in older men, especially those with subacute or chronic symptoms, acellular cerebrospinal fluid and, particularly, if there is neurological deterioration soon after corticosteroid treatment. Patients need early angiography to identify this treatable cause of myelopathy.
- dural fistula
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GAP and DHW are joint first authors.
Contributors GAP and DHW produced the first draft of the case report and discussion. DHW, SH, SA, MP, AC, PRE and AJ were involved in clinical care of the patient and revised the manuscript for important content. All authors approved the final version for publication.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests GAP, DHW, SH, SA, MP, AC and PRE have no relevant disclosures. AJ has received compensation for advisory board, consulting, meeting attendance, and speaking from Biogen, Terumo-BCT, Genentech, Shire and Chugai Pharmaceuticals.
Patient consent Obtained.
Provenance and peer review Not commissioned. Externally peer reviewed by Robin Howard, London, UK