ABSTRACT
Introduction : Dural arteriovenous fistula with spinal drainage is a rare disease that can lead to irreversible neurological deficits if it is not treated quickly. Initial symptoms are nonspecific and may delay diagnosis. We present the case of a patient with spinal lumbar arteriovenous fistula revealed by back pain, gait disorders and urinary urgency
Case report : A 77-year-old female patient was admitted for back pain, instability when walking, and urinary urgency for the last three months. Spinal magnetic resonance imaging then spinal angiography showed a perimedullary arteriovenous fistula fed primarily by the right L3 radicular artery. The patient was treated surgically with closure of the fistula found from L2 to L5 levels. Three and a half months after the operation, there was little improvement of the paraparesis, tingling in the lower limbs and urinary urgency, despite the disappearance of the anomalies on follow-up magnetic resonance imaging
Discussion and Conclusion : Dural spinal fistulas with perimedullary venous drainage are the most frequent intraspinal arteriovenous anomalies. They are rare and often unknown. They cause the appearance of a chronic myelopathy by venous stasis and hypertension. Spinal magnetic resonance imaging supplemented with spinal cord angiography confirms the diagnosis. In the absence of treatment, evolution proceeds slowly towards a permanent paraplegia. Early diagnosis and management can avoid severe neurologic sequelae in most cases