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Cervical spinal epidural arteriovenous fistulae presenting as compressive myelopathy

Journal of Neurology & Stroke
Ganapathy S,1 Ullas A,2 Pandey P3

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Epidural Arterio-venous fistulae (EDAVF) are rare. They occur as abnormal Arterio-Venous or Capillary communications arising from major arteries of the neck or viscera and anastomose with intracranial venous sinuses or intradural spinal venous plexi, thereby short-circuiting the blood flow pathway and causing sudden and sustained venous hypertension. The retrograde flow results in venous bleeds, which may range from small petechiae on the cortical surface to major venous bleeds resulting in severe disability and even death. The shift of blood flow also can result in a steal phenomenon, serious enough to cause infarcts. Mechanical compression of the spinal cord remains thankfully the commonest symptom and is caused by the high flow fistulae leading to medullary and radicular symptoms, especially in conjunction with neurofibromatosis 1.  Proper Identification and management depend on understanding the pathology, location and flow dynamics of the fistula. We present our experience with a large cervical epidural fistula with a review of literature and analysis of management protocols.


epidural av fistula, compressive myelopathy, embolisation