====== Spinal dural arteriovenous fistula differential diagnosis ======

Clinical [[differential diagnosis]] of the rather unspecific neurologic symptoms is manifold, including [[polyneuropathy]], [[tumor]], or [[degenerative disc disease]]s
((Jellema K, Tijssen CC, van Gijn J. Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder. Brain 2006;129:3150–64)).

It, therefore, is not surprising that patients with SDAVF see orthopedic surgeons, urologists ([[urinary retention]] being misinterpreted as being related to prostrate hypertrophy)
((Sheikh SI, Busl KM, Ning M, et al. Spinal dural arteriovenous fistula mimicking prostate hyperplasia. J Emerg Med 2008 Nov 18. [Epub ahead of print]))
or psychologists (erectile dysfunction)
((Jellema K, Tijssen CC, van Rooij WJ, et al. Spinal dural arteriovenous fistulas: long-term follow-up of 44 treated patients. Neurology 2004;62:1839–41))
before the neurologist. From an imaging point of view, the MR imaging findings of cord edema together with perimedullary dilated vessels without any intramedullary nidus of vessels are typical for an SDAVF, and the only viable imaging differential diagnosis is another type of spinal vascular malformation. An SDAVF that drains solely into the anterior spinal veins may go along with cord hypersignal on T2 only because the anterior spinal veins are located subpial and may, therefore, not be visualized as being dilated
((Thiex R, Mayfrank L, Krings T, et al. Delayed diagnosis of spinal dural arteriovenous fistula in the absence of pathological vessels on MRI. Zentralbl Neurochir 2006;67:94–98)).
In these cases, a glioma (especially when contrast uptake is present)
((Roccatagliata L, Centanaro F, Castellan L. Venous congestive myelopathy in spinal dural arteriovenous fistula mimicking neoplasia. Neurol Sci 2007;28:212–15))
, an inflammatory lesion, or spinal ischemia should be in the differential diagnosis
((Krings T, Lasjaunias PL, Hans FJ, et al. Imaging in spinal vascular disease. Neuroimaging Clin N Am 2007;17:57–72)).
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[[Spinal dural arteriovenous fistula]]s (SDAVFs) are considered to be acquired and should be distinguished from congenital intradural [[perimedullary arteriovenous fistula]]s (PMAVFs).
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[[Lumbar puncture]] and [[steroid]] administration for the cases of SDAVF could aggravate the patient's neurological symptoms. Therefore, [[lumbar puncture]] and initiation of [[immunotherapy]] should be avoided until SDAVF is completely excluded in patients with suspected [[myelitis]] on spine MRI without gadolinium-enhancement, even if their neurological symptoms progress rapidly
((Kitazaki Y, Ueno A, Maeda K, Asano R, Miyayama S, Takabatake Y. Rinsho Shinkeigaku. 2020;10.5692/clinicalneurol.cn-001472. doi:10.5692/clinicalneurol.cn-001472)).