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Rehabilitation Practice and Science

Translated Title

脊椎硬膜動靜脈廔管：病例報告

Abstract

A case of delayed diagnosis of spinal dural arteriovenous fistula is presented. A 65-year-old male presented to our clinic for progressive stiffness and numbness over bilateral lower limbs for 6 months. Neurological examination was suggestive of thoracic spinal cord lesion with signs of both upper and lower motor neuron disorders. Electromyographic examination showed evidence of denervation and re-innervation in the bilateral paraspinal muscles of middle thoracic level. Magnetic resonance imaging (MRI) of the spine revealed trivial changes, but they were neglected initially. Because of clinical fluctuation and progressive deterioration, he was treated as early parkinsonism, stroke, amyotrophic lateral sclerosis, transverse myelitis and astrocytoma respectively, but in vain. Two years after the initial MRI, follow-up study demonstrated engorged vessels and secondary ischemic change of the spinal cord resulting from venous hypertension. Thoracic dural arteriovenous fistula was highly suspected and was confirmed by the following angiography. After embolization, his condition stabilized and has gradually improved. With participation in a comprehensive rehabilitation program, he significantly improved in functional mobility and self-care. Spinal dural AVM is often misdiagnosed early in their clinic and image presentation. Appropriate embolization therapy along with an aggressive rehabilitation program will help to prevent progressive disability.

Language

Traditional Chinese

First Page

171

Last Page

180

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