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CASE STUDY #7

10/8/2013

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This is a 66 y/o man who experiences unusual episodes of weakness of the right leg – particularly when climbing hills.  It will become so weak that he will collapse.  Sometimes the weakness is accompanied by burning pain.   The examination is normal.  A MRI of the lumbosacral spine was normal.

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

Clinical Exam (07/10): no longer symptomatic 



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