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

We report a rare case of 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 was suspected to have ALS, but cervical magnetic resonance imaging (MRI) revealed enlarged blood vessels spinal canal, which compressed cord nerve roots. Angiography shunt from vertebral artery intervertebral vein venous plexus; therefore, diagnosed VVAVF. Transarterial embolization performed obliterate shunt, weakness patient’s limb subsequently improved. It is worth considering VVAVF differential diagnosis ALS-like diseases.