Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report
Abstract Background Gadolinium enhancement of spinal nerve roots on magnetic resonance imaging (MRI) has rarely been reported in spinal dural arteriovenous fistula (SDAVF). Nerve root enhancement and cerebrospinal fluid (CSF) pleocytosis can be deceptive and lead to a misdiagnosis of myeloradiculiti...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Neurology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12883-023-03097-7 |
| _version_ | 1811165890096398336 |
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| author | Sharon Chiang Douglas B. Pet Jason F. Talbott Sara C. LaHue Vanja C. Douglas Nicole Rosendale |
| author_facet | Sharon Chiang Douglas B. Pet Jason F. Talbott Sara C. LaHue Vanja C. Douglas Nicole Rosendale |
| author_sort | Sharon Chiang |
| collection | DOAJ |
| description | Abstract Background Gadolinium enhancement of spinal nerve roots on magnetic resonance imaging (MRI) has rarely been reported in spinal dural arteriovenous fistula (SDAVF). Nerve root enhancement and cerebrospinal fluid (CSF) pleocytosis can be deceptive and lead to a misdiagnosis of myeloradiculitis. We report a patient who was initially diagnosed with neurosarcoid myeloradiculitis due to spinal nerve root enhancement, mildly inflammatory cerebrospinal fluid, and pulmonary granulomas, who ultimately was found to have an extensive symptomatic SDAVF. Case presentation A 52-year-old woman presented with a longitudinally extensive spinal cord lesion with associated gadolinium enhancement of the cord and cauda equina nerve roots, and mild lymphocytic pleocytosis. Pulmonary lymph node biopsy revealed non-caseating granulomas and neurosarcoid myeloradiculitis was suspected. She had rapid and profound clinical deterioration after a single dose of steroids. Further work-up with spinal angiography revealed a thoracic SDAVF, which was surgically ligated leading to clinical improvement. Conclusions This case highlights an unexpected presentation of SDAVF with nerve root enhancement and concurrent pulmonary non-caseating granulomas, leading to an initial misdiagnosis with neurosarcoidosis. Nerve root enhancement has only rarely been described in cases of SDAVF; however, as this case highlights, it is an important consideration in the differential diagnosis of non-inflammatory causes of longitudinally extensive myeloradiculopathy with nerve root enhancement. This point is highly salient due to the importance of avoiding misdiagnosis of SDAVF, as interventions such as steroids or epidural injections used to treat inflammatory or infiltrative mimics may worsen symptoms in SDAVF. We review the presentation, diagnosis, and management of SDAVF as well as a proposed diagnostic approach to differentiating SDAVF from inflammatory myeloradiculitis. |
| first_indexed | 2024-04-10T15:43:37Z |
| format | Article |
| id | doaj.art-dec9eb3e02c64242857ffa849ba0d224 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-10T15:43:37Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-dec9eb3e02c64242857ffa849ba0d2242023-02-12T12:15:23ZengBMCBMC Neurology1471-23772023-02-012311610.1186/s12883-023-03097-7Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case reportSharon Chiang0Douglas B. Pet1Jason F. Talbott2Sara C. LaHue3Vanja C. Douglas4Nicole Rosendale5Department of Neurology and Weill Institute for Neurosciences, University of California, San FranciscoDepartment of Neurology and Weill Institute for Neurosciences, University of California, San FranciscoDepartment of Radiology and Biomedical Imaging, University of California, San FranciscoDepartment of Neurology and Weill Institute for Neurosciences, University of California, San FranciscoDepartment of Neurology and Weill Institute for Neurosciences, University of California, San FranciscoDepartment of Neurology and Weill Institute for Neurosciences, University of California, San FranciscoAbstract Background Gadolinium enhancement of spinal nerve roots on magnetic resonance imaging (MRI) has rarely been reported in spinal dural arteriovenous fistula (SDAVF). Nerve root enhancement and cerebrospinal fluid (CSF) pleocytosis can be deceptive and lead to a misdiagnosis of myeloradiculitis. We report a patient who was initially diagnosed with neurosarcoid myeloradiculitis due to spinal nerve root enhancement, mildly inflammatory cerebrospinal fluid, and pulmonary granulomas, who ultimately was found to have an extensive symptomatic SDAVF. Case presentation A 52-year-old woman presented with a longitudinally extensive spinal cord lesion with associated gadolinium enhancement of the cord and cauda equina nerve roots, and mild lymphocytic pleocytosis. Pulmonary lymph node biopsy revealed non-caseating granulomas and neurosarcoid myeloradiculitis was suspected. She had rapid and profound clinical deterioration after a single dose of steroids. Further work-up with spinal angiography revealed a thoracic SDAVF, which was surgically ligated leading to clinical improvement. Conclusions This case highlights an unexpected presentation of SDAVF with nerve root enhancement and concurrent pulmonary non-caseating granulomas, leading to an initial misdiagnosis with neurosarcoidosis. Nerve root enhancement has only rarely been described in cases of SDAVF; however, as this case highlights, it is an important consideration in the differential diagnosis of non-inflammatory causes of longitudinally extensive myeloradiculopathy with nerve root enhancement. This point is highly salient due to the importance of avoiding misdiagnosis of SDAVF, as interventions such as steroids or epidural injections used to treat inflammatory or infiltrative mimics may worsen symptoms in SDAVF. We review the presentation, diagnosis, and management of SDAVF as well as a proposed diagnostic approach to differentiating SDAVF from inflammatory myeloradiculitis.https://doi.org/10.1186/s12883-023-03097-7Spinal dural arteriovenous fistulaSpinal epidural arteriovenous fistula MyeloradiculopathyMyeloradiculitisTransverse myelitisNerve root enhancementCase report |
| spellingShingle | Sharon Chiang Douglas B. Pet Jason F. Talbott Sara C. LaHue Vanja C. Douglas Nicole Rosendale Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report BMC Neurology Spinal dural arteriovenous fistula Spinal epidural arteriovenous fistula Myeloradiculopathy Myeloradiculitis Transverse myelitis Nerve root enhancement Case report |
| title | Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report |
| title_full | Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report |
| title_fullStr | Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report |
| title_full_unstemmed | Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report |
| title_short | Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report |
| title_sort | spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis a case report |
| topic | Spinal dural arteriovenous fistula Spinal epidural arteriovenous fistula Myeloradiculopathy Myeloradiculitis Transverse myelitis Nerve root enhancement Case report |
| url | https://doi.org/10.1186/s12883-023-03097-7 |
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