Cerebrospinal fluid cannot be used to distinguish inflammatory myelitis from congestive myelopathy due to spinal dural arteriovenous fistula: case series

Vinojini Vivekanandam; Vivien Li; Teddy Wu; Richard Dowling; Richard H Roxburgh; Ben J McGuiness; Dean H Kilfoyle; Hadi Manji; Annelies Quaegebeur; Maria Thom; Fergus Robertson; Wesley Thevathasan; Andrew Evans; Stefan Brew; Peter Mitchell

doi:10.1136/bmjno-2019-000019

Cerebrospinal fluid cannot be used to distinguish inflammatory myelitis from congestive myelopathy due to spinal dural arteriovenous fistula: case series

BMJ Neurol Open. 2019 Dec 22;1(1):e000019. doi: 10.1136/bmjno-2019-000019. eCollection 2019.

Authors

Vinojini Vivekanandam^{1

2}, Vivien Li¹, Teddy Wu^{2

3}, Richard Dowling⁴, Richard H Roxburgh⁵, Ben J McGuiness⁶, Dean H Kilfoyle⁵, Hadi Manji¹, Annelies Quaegebeur⁷, Maria Thom⁷, Fergus Robertson⁸, Wesley Thevathasan², Andrew Evans², Stefan Brew⁶, Peter Mitchell⁴

Affiliations

¹ National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
² Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
³ Neurology, Christchurch Hospital, Christchurch, New Zealand.
⁴ Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁵ Neurology, Auckland City Hospital, Auckland, Auckland, New Zealand.
⁶ Radiology, Auckland City Hospital, Auckland, Auckland, New Zealand.
⁷ Neuropathology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
⁸ Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom.

Abstract

Patients with congestive myelopathy due to spinal dural arteriovenous fistula (SDAVF) typically present with progressive sensory and motor disturbance in association with sphincter dysfunction. Spinal MRI usually shows longitudinally extensive T2 signal change. Here, we report four patients with progressive myelopathy due to SDAVF who also presented with findings on cerebrospinal fluid (CSF) examination suggestive of an inflammatory aetiology. Such CSF findings in SDAVF are important to recognise, to avoid the erroneous diagnosis of an inflammatory myelitis and inappropriate treatment with immunosuppression. SDAVF can be difficult to detect and may require repeated investigation, with formal angiography as the gold standard.

Keywords: CSF; MRI; myelopathy; neuropathology; neuroradiology.