Congestive myelopathy due to craniocervical junction arteriovenous fistulas mimicking transverse myelitis: a multicenter study on 27 cases.
Keisuke TakaiToshiki EndoToshitaka SekiTomoo Inouenull nullPublished in: Journal of neurology (2022)
The myelopathy of CCJ AVFs was characterized by acute ascending paralysis in elderly men. A misdiagnosis was common because of the acute presentation due to a longitudinally extensive spinal cord lesion. Dilated vessels on MRI were a key finding for the correct diagnosis. What is already known on this topic? Slowly progressive myelopathy is a well-known symptom that results from impaired spinal venous drainage due to thoracolumbar AVFs. Although cranio-cervical junction arteriovenous fistulas (CCJ AVFs) constitute a treatable cause of congestive myelopathy, detailed information is not currently available due to their rarity. What does this study add? CCJ AVFs often presented with acute ascending myelopathy in elderly men due to a longitudinally extending cervical cord lesion with surrounding flow voids. Steroid pulse therapy was not effective or even harmful to congestive myelopathy, while neurosurgical treatment effectively obliterated AVFs. How might this study affect research, practice or policy? The results obtained revealed diagnostic clues and pitfalls from the largest dataset of patients with CCJ AVFs in a multicenter cohort.
Keyphrases
- spinal cord
- liver failure
- spinal cord injury
- neuropathic pain
- aortic dissection
- middle aged
- respiratory failure
- healthcare
- drug induced
- multiple sclerosis
- magnetic resonance imaging
- blood pressure
- public health
- mental health
- pulmonary artery
- magnetic resonance
- community dwelling
- single cell
- stem cells
- intensive care unit
- health information
- cross sectional
- case report
- acute respiratory distress syndrome
- diffusion weighted imaging