Veins of Deception: An Intriguing Case of Extradural Spinal AVF Mimicking Longitudinal Extensive Transverse Myelitis

Abstract

Longitudinally extensive transverse myelitis (LETM) is a rapidly progressing demyelinating disease affecting the spinal cord over three or more vertebral segments. Acquired central nervous system demyelinating diseases such as multiple sclerosis, neuromyelitis optica, systemic autoimmune causes, infections, and post-vaccination are common reasons; the majority is idiopathic. Vascular disorders of the spinal cord potentially can cause long segment spinal involvement mimicking LETM. Spinal dural arteriovenous fistulas represent approximately 70% of all spinal vascular malformations. Spinal extradural arteriovenous fistulas (AVFs) are relatively uncommon vascular disorders also mimicking LETM. Here, we present a very rare case of extradural spinal AVF mimicking LETM.

Keywords

spinal extradural AVF - AVF - spinal angiography - DSA - paraplegia - dural AVF

Publikationsverlauf

Artikel online veröffentlicht:
20. Juni 2025

• References

• 1 Paudel S, Nepal G, Guragain S. et al. Longitudinally extensive transverse myelitis: a retrospective study differentiating neuromyelitis optica spectrum disorder from other etiologies. Cureus 2021; 13 (03) e13968
• 2 Shah D, Mohajery M, Rubin A, Pandey K. Vascular malformations mimicking longitudinally extensive transverse myelitis: cases of misdiagnosis and successful intervention (P1–5.031). Neurology 2024; 102 (17) 5701
• 3 Msheik A, Al Mokdad Z, Gerges T, Aoude A. Spinal dural arteriovenous fistula: insights into operative management. Cureus 2023; 15 (05) e38448
• 4 Goyal S, Sinha AK, Agarwal HN. Completely extradural spinal arteriovenous fistula (abnormal direct connection between arteries and extradural venous plexus) with totally extradural venous drainage causing compressive cervical myelopathy. Asian J Neurosurg 2020; 15 (04) 1081-1084
• 5 Rangel-Castilla L, Holman PJ, Krishna C, Trask TW, Klucznik RP, Diaz OM. Spinal extradural arteriovenous fistulas: a clinical and radiological description of different types and their novel treatment with Onyx. J Neurosurg Spine 2011; 15 (05) 541-549
• 6 Takai K, Taniguchi M. Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: a systematic literature review. Neurosurg Focus 2012; 32 (05) E8
• 7 Huang W, Gross BA, Du R. Spinal extradural arteriovenous fistulas: clinical article. J Neurosurg Spine 2013; 19 (05) 582-590
• 8 Byun JS, Tsang ACO, Hilditch CA. et al. Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas: a systematic review and meta-analysis. J Neurointerv Surg 2019; 11 (01) 95-98
• 9 Brinjikji W, Yin R, Nasr DM, Lanzino G. Spinal epidural arteriovenous fistulas. J Neurointerv Surg 2016; 8 (12) 1305-1310
• 10 Vercelli GG, Minardi M, Bergui M, Zenga F, Garbossa D, Cofano F. Spinal dural and epidural arteriovenous fistula: recurrence rate after surgical and endovascular treatment. Front Surg 2023; 10: 1148968