SPINAL DURAL ARTERIOVENOUS FISTULA: A RARE CAUSE OF PROGRESSIVE PARAPARESIS

Spinal dural arteriovenous fistula (dAVF) is a rare and disabling but potentially treatable vascular malformation of the spine. The lesion is more common in men over the age of 50 years and affects the thoracic and lumbar spine. These patients usually present with slow and progressive paraparesis with both upper and lower motor neuron lesion findings, which hinders the clinical differentiation of spinal dAVF from polyneuropathies and other causes of myelopathies. Available treatment includes endovascular embolization and microsurgical techniques. Because a patient's prognosis is strongly correlated with the time of the diagnosis and early treatment, spinal dAVF should always be considered in the differential diagnosis of patients with paraparesis. A 65-year-old male patient was admitted to our clinic with a 3-month history of progressive bilateral lower extremity weakness. Neurological examination revealed hypoesthesia in the L4 dermatome bilaterally, and the strength in the bilateral hip flexors and knee extensor muscles was 4/5. On contrast magnetic resonance imaging, vascular structures surrounding the dural sac were prominent in the lumbar and thoracic regions. In angiography a spinal dAVF was detected. Following the worsening of the patient's paraparesis, endovascular embolization was applied to the fistula. Patient's clinic completely restored after the procedure. In this report, it has been aimed to present a male patient who admitted with progressive paraparesis and diagnosed as subsequent lumbar dAVF in the light of updated literature.