Unmasking a Challenging Neurological Diagnosis: A Case Report of Spinal Dural Arteriovenous Fistula

Introduction Spinal dural arteriovenous fistula (SDAVF) is a rare condition, affecting 0.5 to 1 in 100,000 people annually, primarily middle-aged men [1]. Due to variable clinical presentations, diagnosis is often delayed, leading to neurological deficits [2]. We present a case of successful diagnosis and treatment of SDAVF, emphasizing the importance of early recognition and intervention. Case Presentation A 29-year-old male presented with a one-month history of lumbosacral pain, two weeks of perineal hypoesthesia, one week of progressing dorsal feet hypoesthesia, and three days of obstipation and difficulty urinating. Neurological examination revealed mild bilateral proximal muscle weakness in the legs (grade 4/5), hypoesthesia in the S1 region, mild imbalance in Romberg’s position, and pelvic organs disfunction, including obstipation and urinary retention. Spinal magnetic resonance imaging (MRI) revealed myelopathic changes extending from the third thoracic segment downward, along with a prominently visible perimedullary venous plexus. Spinal angiography (SA) subsequently confirmed a SDAVF. The patient underwent successful catheter embolization, resulting in regression of neurological deficits. Discussion SDAVFs are abnormal connections between arteries and veins within the dura mater, mostly located in the lower thoracic and upper lumbar regions [1,4]. SDAVFs, though rare, account for 70-80% of all spinal vascular lesions [4]. Venous sinus thrombosis and hypertension have been suggested as potential causes of SDAVF. Gait abnormality, lower-extremity weakness, sensory disturbances, pain, sphincter and erectile dysfunctions are the most presented symptoms. [1,2]. Diagnosis involves MRI and SA. The treatment options include endovascular embolization, microsurgical disconnection, and stereotactic radiosurgery. The prognosis depends on the lesion’s severity and the treatment’s timeliness [4,5]. Conclusions Early investigations with MRI and SA were pivotal in establishing the diagnosis of SDAVF. Subsequent catheter embolization significantly improved neurological symptoms, emphasizing the critical role of early recognition and intervention in affected patients.