Spinal dural arteriovenous fistula - post-traumatic

Case contributed by Dr Irvine Sihlahla

Presentation

History of a stab wound to the neck with neck swelling, odynophagia and dysphagia. The patient represented 3 years later with upper limb weakness and inability to walk.

Patient Data

Age: 45 years
Gender: Male

Transcervical stab wound tract with soft tissue swelling and subcutaneous emphysema. No active contrast extravasation or pseudoaneurysm. Left-sided intercostal drain with basal hemothorax and compressive atelectasis. Motion artifact during the study

Limited views

Fluoroscopy

Limited static images from a fluoroscopic swallow demonstrate esophageal injury with extra-luminal contrast extravasation into the neck soft tissues.

Large pseudoaneurysm arising from the proximal right subclavian artery with draining vessels extending into the cervical spine from C2/C3 to T1/T2 level. Associated communication with epidural vessels. There is the communication of the pseudoaneurysm with the proximal right internal jugular vein which is arterialized.

Large right-sided arteriovenous fistula draining into epidural venous plexus surrounding the lower cervical and upper thoracic cord with cervical myelopathic changes. Massively distended urinary bladder

Extensive arteriovenous fistula of the right neck with dilated intraspinal plexus. The arteriovenous fistula is being fed from the subclavian pseudoaneurysm. Multiple coiling is done with residual filling of the arteriovenous fistula.

Case Discussion

The case demonstrates a large dural arteriovenous fistula between neck vessels and the epidural vessels via a giant fistula (type IV, subtype III) and penetrating esophageal injury. The patient subsequently underwent multiple angioembolization and open surgery in order to treat the post-traumatic dural arteriovenous fistula.

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