A dural arteriovenous fistula masquerading as myelitis- A case report

Introduction - Intracranial dural Arteriovenous Fistulas (dAVFs) are rare vascular malformations with diverse clinical manifestations due to ischemia secondary to venous congestion or haemorrhage. Our case clinically and radiologically closely mimicked myelitis. Case- We present a 58-year-old male with quadriparesis and bulbar involvement mimicking myelitis on MRI, not responding to the initial treatment with Intravenous Methylprednisolone (IVMPS) and Intravenous Immunoglobulin (IVIg). On subsequent visit to our center, repeat scanning revealed serpentine flow voids on the anterior surface of the cord. Digital Substraction Angiography (DSA) revealed a posterior fossa dAVF which was successfully obliterated with embolization leading to marked symptomatic improvement. Conclusion- A high degree of suspicion is required when imaging suggestive of myelitis doesnot respond to immunomodulatory therapy. Imaging appearance of serpentine flow voids shall be closely looked for in all cases with myelitis.