title: A unique presentation of a spinal dural arteriovenous fistula exacerbated by steroids.
abstract: Spinal dural arteriovenous fistula (DAVF) is an acquired vascular malformation of the spinal cord that presents as a congestive myelopathy resulting from venous hypertension, edema, and ischemia within the cord. Acute clinical exacerbations have been demonstrated in a variety of clinical settings. We report a unique presentation of a 45-year-old male with progressive paraplegia that acutely worsened following three independent treatments with oral and intravenous steroid administration. Spinal angiogram revealed a spinal DAVF at L3 and the patient underwent successful surgical repair. This report highlights the clinical presentation of spinal DAVF and emphasizes the unique and important potential relationship between steroid administration and clinical deterioration.
authors.affiliation: Department of Neurology, Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC 27157, USA. rstrowd@wfubmc.edu
authors.forename: Roy E
authors.initials: RE
authors.lastname: Strowd
authors.forename: Carol
authors.initials: C
authors.lastname: Geer
authors.forename: Alexander
authors.initials: A
authors.lastname: Powers
authors.forename: Nuhad
authors.initials: N
authors.lastname: Abou-Zeid
mesh_terms: D000707:Anaphylaxis / Q000188:drug therapy / Q000209:etiology; D000792:Angiography; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D001164:Arteriovenous Fistula / Q000139:chemically induced* / Q000473:pathology* / Q000601:surgery; D004388:Dura Mater / Q000098:blood supply; D004576:Electromyography; D005512:Food Hypersensitivity / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D020335:Paraparesis / Q000139:chemically induced / Q000209:etiology; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D017747:Seafood / Q000009:adverse effects; D013122:Spinal Diseases / Q000139:chemically induced* / Q000473:pathology*; D013256:Steroids / Q000009:adverse effects*; D014656:Vascular Surgical Procedures
chemical_list: D000893:Anti-Inflammatory Agents; D013256:Steroids; D011241:Prednisone