Spinal Dural Arteriovenous Fistula (SDAVF) is the most common vascular abnormality of the spinal cord; however in clinical practice it is rare with average time to diagnosis of 22 months. SDAVF is a cause of reversible myelopathy, hence the importance of diagnosis and early treatment. Here we present a case of a 51 year old male with a 1 year history of bilateral radicular leg pain and difficulty walking with symptoms becoming more prominent after 10 min walking. Neurological examination was normal. Initial MRI spine showed enhanced swollen distal cord with abnormally thickened enhancing spinal nerve roots in this area, and prominent veins at the level of T8-T9. SDAVF is usually diagnosed on MRI spine where there is cord oedema, cord enhancement and dilated perimedullary blood vessels. Spinal nerve roots enhancement is not a common feature of SDAVF and therefore, we had to exclude an infiltrative malignant or inflammatory process. Time resolved imaging of contrast kinetics (TRICKs) scan confirmed SDAVF at thoracic segment of spinal cord and digital subtraction angiogram localised the fistula at T9. Patient had surgical ligation with good clinical recovery.Conclusion
Spinal Dural Arteriovenous Fistula should be considered in myelopathy, even in the presence of nerve root enhancement, especially where there is a typical history. Early investigation with vascular imaging and endovascular or surgical intervention is important to improve prognosis.