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A difficult case
Intracranial dural arteriovenous fistula mistaken as cervical transverse myelitis
  1. Gowri A Peethambar1,
  2. Daniel H Whittam2,
  3. Saif Huda2,
  4. Sundus Alusi2,
  5. Mani Puthuran3,
  6. Arun Chandran3,
  7. Paul R Eldridge4,5,
  8. Anu Jacob2,5
  1. 1 Trivandrum Medical College, Thiruvananthapuram, Kerala, India
  2. 2 Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
  3. 3 Interventional Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
  4. 4 Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
  5. 5 School of Medicine, The University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Anu Jacob, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; anu.jacob{at}thewaltoncentre.nhs.uk

Abstract

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.

  • myelopathy
  • dural fistula
  • myelitis

https://doi.org/10.1136/practneurol-2018-002091

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    Footnotes

    • 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