Abstract

Spinal arteriovenous malformations (AVMs) are a rare form of spinal blood vessel defect that result in engorgement of the vessel leading to clinical manifestations due to mass effect and cord ischemia. They are a heterogeneous group that can cause acute, subacute, or chronic spinal cord dysfunction. Most of these patients present to the Emergency Department (ED) after a prolonged course with severe neurological disability. Spinal vascular lesions comprise approximately 3-4 % of all intradural spinal lesions. When it comes to clinical impact, these lesions have a comparatively worse curve when compared to their intracranial counterparts. We describe the case of a 32-year-old female with no previous medical co-morbid conditions, who presented to us with the symptoms of progressive bilateral lower limb weakness since 3 weeks, with the subsequent inability to stand. There was no urinary bladder or bowel involvement. Her physical examination was positive for lower truncal and lower limb proximal muscle weakness (left > right), with diminished sensations corresponding to the T9-T10 dermatome levels. Magnetic resonance imaging (MRI) of the thoraco-lumbar spine showed a type IV vascular malformation in the left anterior perimedullary region of T10 vertebra spanning to L1. Unfortunately, the patient left the Emergency Department against medical advice, due to severe financial constraints, and was lost to follow-up. We believe this case to be of clinical value because intradural perimedullary arteriovenous fistula are rare, with true incidence rates not yet defined. Our aim is to highlight this extremely uncommon cause of myelopathy presenting as progressive paraparesis in the Emergency Department.

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