A Rare Presentation In The Differential Diagnosis of Paraparesis: Spinal Dural Arteriovenous Fistula - A Case Report

Spinal dural arteriovenous fistulas (SDAVFs) are acquired vascular malformations characterized by spinal cord dysfunction.Patients present with symptoms such as paraparesis, sensory deficits and dysfunction of the bowel and bladder.The gold standard in diagnosis is spinal angiography.However, delays in diagnosis and treatment are common.In this article, we aim to present a case of SDAVF presenting with paraparesis and urinary incontinence.A 40-year-old male patient presented to our clinic with weakness in the legs and difficulty urinating following an upper respiratory tract infection.Neurological examination revealed paraparesis consistent with a 1st motor neuron lesion and sensory deficit was present starting from level T9.Spinal cord MRI showed hyperintense signal changes on T2-weighted sequences enhancing from the T5 to L1 vertebral levels.Spinal MR angiography performed with the diagnosis of SDAVF revealed a vascular lesion resembling SDAVF extending between T4 and L2 vertebrae and the patient underwent endovascular embolization therapy.SDAVFs most commonly occur in the thoracolumbar region and predominantly affect middle-aged male patients.The absence of a typical clinical presentation complicates early diagnosis at initial presentation.Delayed diagnosis can lead to further neurological deficits and more severe outcomes.Therefore, in cases presenting with paraparesis and extensive hyperintense lesions on MRI, SDAVF should always be considered in the differential diagnosis.