Spinal dural arteriovenous fistula incidentally discovered

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-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

Figure 2.

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

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.