# Case Report: Vertebro-vertebral arteriovenous fistula showing symptoms mimicking ALS: Diagnostic imaging supports accurate differentiation between ALS and mimicking conditions

## TL;DR

A rare case of a spinal blood vessel abnormality was mistaken for ALS, but imaging and treatment led to accurate diagnosis and improvement.

## Contribution

Highlights VVAVF as a rare but important differential diagnosis for ALS-like symptoms.

## Key findings

- MRI and angiography identified a vertebro-vertebral arteriovenous fistula compressing the spinal cord.
- Treatment with transarterial embolization improved the patient's symptoms.
- VVAVF should be considered in the differential diagnosis of ALS-like conditions.

## Abstract

We report a rare case of a vertebro-vertebral arteriovenous fistula (VVAVF) manifesting as amyotrophic lateral sclerosis (ALS). A 76-year-old female patient presented with progressive weakness, muscle atrophy, fasciculation, and preserved deep tendon reflexes in the right upper limb. Electrophysiological testing showed lower motor neuron dysfunction. The patient was suspected to have ALS, but cervical magnetic resonance imaging (MRI) revealed enlarged blood vessels in the spinal canal, which compressed the cervical spinal cord and nerve roots. Angiography showed a shunt from the right vertebral artery to the right intervertebral vein and the vertebral venous plexus; therefore, the patient was diagnosed with VVAVF. Transarterial embolization was performed to obliterate the shunt, and weakness in the patient’s right upper limb subsequently improved. It is worth considering VVAVF as a differential diagnosis of ALS-like diseases.