• Abdelrahman Abdelazim, Cory Hartman, Kristopher Hooten, Andrew Cutler, and Spiros Blackburn.
• Department of Neurosurgery, University of Texas UT Health Medical System, Houston, Texas, USA.
• World Neurosurg. 2016 Aug 1; 92: 587.e15-587.e18.

BackgroundAlthough angiography does not generally lead to increased clinically significant neurologic deficits, it has been reported that angiography for spinal dural arteriovenous fistulas (SDAVFs) can lead to acute neurologic decline. This has been rarely reported, and outcome after decline and the subsequent intervention performed have not been clarified. We describe a patient with SDAVF who experienced acute neurologic decline shortly after spinal angiography. Acute surgical treatment resulted in improvement of symptoms.Case DescriptionA 70-year-old woman presented following 5 months of progressive numbness and weakness in her lower extremities. Spinal magnetic resonance imaging revealed thoracic spinal cord edema. Spinal angiography revealed a type 1 SDAVF. Several hours after spinal angiography, the patient's lower extremity motor strength declined significantly. This neurologic change led to emergent surgical intervention and ligation of the SDAVF. The patient's neurologic decline subsequently improved and ultimately resolved completely.ConclusionsAlthough acute worsening of neurologic deficits is a rare complication following angiography of SDAVFs, the reversibility of these deficits by emergent intervention argues for careful surveillance after angiography with protocols in place to rapidly intervene if needed. Warming and diluting the contrast agent should be considered to reduce contrast viscosity, a potential aggravating factor to the venous congestion of spinal fistulas.Copyright © 2016 Elsevier Inc. All rights reserved.

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