title: [Spinal dural arteriovenous fistula: frequently diagnosed late].
abstract: BACKGROUND
  The diagnosis of spinal dural arteriovenous fistula (SDAVF) is often established relatively late. In this case, we describe early clinical and radiological signs of SDAVF.
  
  
  METHODS
  A 53-year-old patient presented with sensory deficits and disturbances related to gait, mictition and defecation. Neurological examination revealed signs of polyradiculoneuropathy. An MRI scan of the vertebral column showed swelling of the myelum and dilated perimedullary vasculature; digital subtraction angiography revealed an SDAVF. The fistula was approached surgically by hemilaminectomy after which it was successfully occluded.
  
  
  CONCLUSIONS
  An SDAVF is a connection between a radicular arteria and a radicular vein, resulting in venous hypertension and obstruction of the venous flow. Consequently, oedema forms beneath the fistula and congestive ischaemia of the myelum develops. Initial symptoms are sensory or disturbances related to gait; later, disturbances in micturition, defecation or erection may occur. Digital subtraction angiography is the gold standard. Treatment consists of surgical or endovascular occlusion of the fistula. Early recognition and treatment of SDAVF are essential for a good prognosis.
authors.affiliation: UMC St Radboud, Nijmegen, the Netherlands. j.wilbers@neuro.umcn.nl
authors.forename: Joyce
authors.initials: J
authors.lastname: Wilbers
authors.forename: Frederick J A
authors.initials: FJ
authors.lastname: Meijer
authors.forename: Anil
authors.initials: A
authors.lastname: Tuladhar
authors.forename: Joost
authors.initials: J
authors.lastname: de Vries
authors.forename: Ewoud
authors.initials: E
authors.lastname: van Dijk
authors.forename: Jeroen D
authors.initials: JD
authors.lastname: Boogaarts
mesh_terms: D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D057210:Delayed Diagnosis; D005402:Fistula / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000601:surgery; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome