I performed an EMG study which showed clear signs of a right L5 radiculopathy. I reviewed the prior MRI scan of the lumbar spine and in reality there were signs for a possible dural AV fistula. I sent him for an iodine angiogram study.
The angiogram shows a dural arterio-vascular malformation (AVM) supplied by an artery at the L3 level.
DIAGNOSIS: Spinal Dural AVM
- MRI: T2 signal in cord with a large vessel flow channel concerning for dural AVF.
- Angiogram: Right L3 supply to spinal epidural AVF
- Embolized with onyx (01/10)
- MRI lumbar spine (04/10): diminishing edema at T11/T12
- Angiogram (07/10): no evidence of residual AVF