Presentation
Low back pain and right leg radicular pain. Right leg pain has resolved and 4-6/52 history of worsening left leg weakness and instability. Left leg weakness multidermatomal from L2-S1. Reduced reflexes on leg and brisk on right. No left leg pain or paresthesia. Signs of reduced coordination left leg and new onset of all 4 limbs resting tremor. MRI urgent whole spine to help assess for myelopathy signs, space-occupying lesion.
Patient Data
Edema in the conus and lower cord with serpinginous flow voids in the surrounding CSF.
The rest of the cord is of normal signal. No other central canal stenosis.
Mild degenerative disc disease noted in the cervical spine with disc bulges indenting the anterior CSF space.
Vertebral bodies are of normal height and alignment.
Several small T1, T2 hyperintense foci in multiple vertebral bodies in line with hemangiomas.
Moderate-severe central canal stenosis at L4/L5 due to a combination of posterior disc bulge, laxity of ligament flavum and hypertrophic facets.
T7/T8 posterior disc bulge indenting the thecal sac.
Case Discussion
This patient's symptoms are fitting with those described in those with a spinal dural arteriovenous fistula. This occurs from the cord edema that results from venous hypertension and venous congestion of the cord with edema.
The patient was referred to a tertiary center for further management.
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