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A TREATABLE BUT ‘MISSABLE’ MYELOPATHY
  1. Lliwen Jones,
  2. Ann Johnston
  1. University Hospital of Wales

Abstract

We report two cases of spinal dural AV fistula (dAVF); a potentially reversible myelopathy causing disability which is easily missed in non-specialist hands, due to its insidious onset, commoner differential diagnoses and subtle imaging findings.

Case 1: A 69-year-old woman described four years of progressive leg weakness, constipation and urinary incontinence. Examination showed proximal muscle wasting, weakness, absent knee reflexes and diminished proprioception. MRI demonstrated an expanded cord with high signal from T6 to the conus with abnormal flow voids within the theca.

Case 2: A 54-year-old man presented with a 12-month history of leg sensory symptoms, worsening mobility and erectile dysfunction. Examination showed bilateral pyramidal weakness. MRI spine showed cord expansion between T9 and T12/L1 with dural vessels.

Neuroradiological review suggested both cases were consistent with dAVF, later confirmed on angiography. Both were treated surgically with a combination of clipping, excision, laminectomy and laminoplasty.

Both patients have improved motor function following surgery and rehabilitation however sphincter function remains problematic. A timely diagnosis is essential as early surgical intervention optimises prognosis.

In light of these cases we propose a dAVF clinical checklist to assist the clinician in their diagnostic questioning of: age, progressive predominantly motor disability and sphincter involvement.

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