General Poster Session
AB137. SOH24AB_114. A rare presentation of a sacral dural arteriovenous fistula: a case report
Lena Dablouk1, Michael Amoo2, Vincent Healy2, Mahmoud Kamel2, Orlaith O’Connell3, Isabelle Hunt3, Orna O’Toole4, Gerard Wyse5
1Brookfield Health Science Complex, School of Medicine, University College Cork, Cork, Ireland;
2Department of Neurosurgery, Cork University Hospital, Wilton, Cork, Ireland;
3Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland;
4Department of Neurology, Mercy University Hospital, Cork, Ireland;
5Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
Background: Sacral dural arteriovenous fistulas (DAVF) are rare presentations and are often undiagnosed. They most commonly affect the thoracolumbar region, consisting of a pathological communication between arterial and venous vessels in the spinal dural sheath, which gives rise to symptoms similar to those of other spinal cord disorders.
Case Description: A 72-year-old gentleman presented with a 6-month history of lower back pain and a rapid progression of lower limb weakness, along with a reduction in bladder and bowel function. His past medical history was significant for hypertension, atrial fibrillation and hyperlipidaemia. Significant findings on examination included increased tone and hyperreflexia in the lower limbs, along with a positive Babinski sign bilaterally. He also had a post-void residual volume of 350 mL. Neurosurgical intervention was carried out with a transpedicular T5/6 discectomy. Symptoms improved for weeks before rapidly deteriorating. Intramuscular corticosteroid injections worsened the patient’s symptoms. Magnetic resonance angiography (MRA) revealed a DAVF from T9–12. Spinal angiography revealed a right sacral DAVF at the level of S5, which was treated by embolization. The patient’s lower limb weakness subsequently resolved and he was able to mobilise with a rollator.
Conclusions: Diagnosis of a sacral DAVF is complicated due to its presentation with non-specific progressive spinal cord symptoms, as portrayed by this case. MRA imaging is therefore an important investigation for this condition as it can prevent delays in management. Treatment options include endovascular embolization or surgical ligation of the fistula, both of which have proven to be effective.
Keywords: Arteriovenous fistula; interventional radiology; neurosurgery; sacral dural arteriovenous fistula; spinal angiography
Acknowledgments
Funding: None.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/map-24-ab137
Cite this abstract as: Dablouk L, Amoo M, Healy V, Kamel M, O’Connell O, Hunt I, O’Toole O, Wyse G. AB137. SOH24AB_114. A rare presentation of a sacral dural arteriovenous fistula: a case report. Mesentery Peritoneum 2024;8:AB137.
