Spinal dural arteriovenous fistulas presenting as intracranial subarachnoid hemorrhage: A systematic review.
Bridget Nolan, Christian Rajkovic, Galadu Subah et al.
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Case in brief
This systematic review identified 80 patients with subarachnoid hemorrhage associated with spinal dural arteriovenous fistulas (SDAVFs), drawn from 45 studies. Fistulas were most often cervical (57.5%) or at the craniocervical junction (35%). Treatment included open surgical ligation, endovascular embolization, or surgery after persistent symptoms following embolization; reported outcomes were generally favorable, with two mortalities (2.5%). The authors also describe a case of hemorrhage from a C1-C2 SDAVF that persisted despite multiple endovascular and open surgical interventions.
What made this case unusual
The review highlights intracranial subarachnoid hemorrhage as an uncommon presentation of SDAVF, which more typically causes symptoms of thoracolumbar myelopathy. Its accompanying case was refractory to multiple endovascular and open surgical procedures.
Diagnostic / clinical pearl
When subarachnoid hemorrhage has no evident intracranial source, consider a spinal dural arteriovenous fistula, particularly in the cervical spine or craniocervical junction.