{
  "abstract": "Introduction Vertebro-vertebral venous fistulas (VVFs) are uncommon vascular disorders with abnormal direct communication between the vertebral artery and vertebral venous plexus. Typically, these patients present with neck pain, tinnitus, or posterior circulation ischaemia. We report a case of both VVF and spinal epidural hematoma formation, following vertebral artery dissection presenting with radicular symptoms and cerebellar infarcts.Abstract C73 Figure 1Case Description A 74-year-old man with lower limb diplegia from poliomyelitis and atrial fibrillation, on apixaban, developed severe radicular pain, weakness and numbness in right neck and upper limb following neck massage. He also developed sudden unsteady gait and clumsiness of right hand, prompting hospital admission.Examination revealed right C5-C7 myotome weakness, absent biceps, supinator, triceps reflexes and reduced right C6 dermatome sensation. Electromyography showed active denervation of right C5 and C6 myotomes.Brain and cervical spine CT/MR imaging demonstrated bilateral cerebellar infarcts, right vertebral artery dissection and acute right lateral spinal epidural haematoma from C4 to C6 levels, compressing the cervical nerve roots. DSA revealed dissection of the V3 segment of right vertebral artery with development of VVF.Patient underwent successful embolisation of the dissection and VVF through right vertebral artery sacrifice. He had complete recovery with no evidence of VVF on follow-up MR angiogram 5 months later.Abstract C73 Figure 2Conclusions This case highlights a rare presentation of both VVF and spinal epidural haematoma development following vertebral artery dissection. It also underscores the risks of neck manipulation and importance of timely intervention.Abstract C73 Figure 3Conflict of Interest No",
  "authors": [
    {
      "affiliations": [
        "National Neuroscience Institute, Singapore, Singapore"
      ],
      "name": "Khin Hnin Su Wai"
    },
    {
      "affiliations": [
        "National Neuroscience Institute, Singapore, Singapore"
      ],
      "name": "Saravana Kumar Swaminathan"
    }
  ],
  "title": "C73 Simultaneous vertebro-vertebral venous fistula and spinal epidural hematoma development secondary to vetebral artery dissection",
  "uid": "39f2a1bb-6857-5d3f-94f0-613305b8e423"
}