Arteriovenous malformation mimicking tuberculosis of spine with myelitis

Abstract Arteriovenous malformations of the spinal cord are a rare cause of neurological impairment and they represent 5% of all intraspinal pathology. They can occur anywhere in the spinal cord from occiput to coccyx and they can present in any way. Here we report a case of AV malformation of the spinal cord which was diagnosed as tuberculosis of the spine and presented as paraperesis. A 27 year old male presented to us with gradually progressive weakness of both lower limbs for 5 months and difficulty in micturition and defaecation for 5 days. He was investigated at his local place and was diagnosed as tuberculosis spine with myelitis and was on antitubercular therapy (ATT) for 5 months. However the symptoms worsened and at the time of presentation to us he had grade 1 power in bilateral lower limbs with decreased sensation below D12 and with bowel and bladder involvement. MRI showed signal intensity changes in multiple vertebrae which was hyperintense in both T1 and T2 weighted images and signal intensity changes in the spinal cord. An urgent digital subtraction angiogram was performed which revealed type I AV malformation at D11 level which was treated surgically by laminectomy and cauterization of the fistula. The power increased to grade 4 on the 5th postoperative day but however the bladder and bowel symptoms persisted. Spinal AV malformations should be entertained in the differential diagnosis of progressive myelopathy of uncertain etiology and when the clinical findings are not correlating with imaging findings. Advanced imaging studies like spinal MRA or CTA should be used to screen these lesions and spinal digital subtraction angiogram is the gold standard for diagnosing AV malformations. Early and prompt diagnosis and management in these cases in the form of complete occlusion of the fistula will prevent any further neurological deterioration.