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KMID : 0390320070170020216
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Chungbuk Medical Journal
2007 Volume.17 No. 2 p.216 ~ p.222
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Cervical dural arteriovenous fistula causing progressive ascending quadriplegia and respiratory paralysis
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Sung Kook-Han
Min Kyung-Soo
Lee Mou-Seop
Kim Dong-Ho
Kim Young-Gyu
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Abstract
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Spinal dural arteriovenous fistulas (DAVF) are found most commonly at the thoracolumbar region and DAVFs involving the cervical or craniocervical junctions are uncommon. Frequent clinical manifestations are subarachnoid hemorrhage, slowly progressive ascending myelopathy involving first the lower then the upper limbs, and bulbar symptoms. Authors report a case of cervical DAVF which caused acute progressive ascending quadriplegia and respiratory paralysis, mimicking Gullain-Barre syndrome. 67-year old male was transferred to our hospital because of progressive ascending paralysis during last 3 days with the diagnostic impression of Gullain-Barre syndrome. Spinal MRI showed makedly edematous cervial spinal cord and medulla with enlarged perimedullary veins in coiled and tortous appearance. Angiography confirmed DAVF fed from radiculomeningeal branch of right vertebral artery at C1-2 level. We treated the patient successfully with emergency embolization of major fistula followed by later surgical ligation of small residual DAVFs. Because DAVFs involving upper cervial and craniocervical junction may cause relentlessly progressive respirator dependent quadriplegia, early diagnosis and appropriate management is very important.
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KEYWORD
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Arteriovenous fistula, Myelopathy, Respiratory aralysis, mbolization
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