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
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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