Progressive quadriparesis in a young woman due to a spinal perimedullary arteriovenous fistula (PMAVF type IVa) successfully treated with endovascular therapy: A case report

A perimedullary arteriovenous fistula (PMAVF) is a rare spinal vascular malformation that can lead to progressive neurologic deficits. We report a case of a 23-year-old woman presenting with progressive quadriparesis over 6 months. Initial spinal MRI revealed serpiginous flow voids from the cervical to the lumbar region, indicating abnormal vessels. Subsequent spinal angiography confirmed a PMAVF type IVa arising from the anterior radiculomedullary artery at the tenth thoracal (T10) level, shunting directly into a dilated perimedullary venous system. Transarterial embolization using ethylene-vinyl alcohol copolymer (Onyx) successfully occluded the fistula without compromising normal arterial flow. The patient showed marked neurologic recovery, achieving near-complete motor improvement by the seventh day postprocedure. PMAVF is classified as a type IV spinal vascular malformation and may cause severe neurologic symptoms due to venous hypertension, congestion, or hemorrhage. Early diagnosis is crucial, as endovascular embolization offers a minimally invasive treatment option with a favorable safety profile. This case illustrates the importance of timely recognition and intervention in PMAVF, underscoring the potential for significant functional improvement following endovascular therapy.