Disclosures: Matthew A. Cascio, DO: No financial relationships or conflicts of interest

Case Diagnosis: Fall with hip fracture with prior spinal dural ateriovenous fistula

Case Description or Program Description: A 76-year-old female presented to the emergency department with right hip pain after falling. She endorsed a history of a thoracic spinal dural ateriovenous fistula (sdAVF). She noted progressive left lower extremity weakness and numbness starting 10 years prior. She initially underwent EMG, with the diagnosis of sdAVF confirmed by MRI. She underwent embolization of the sdAVF with some initial symptomatic improvement, however noted continued weakness which had led to her fall. Before falling she ambulated with a cane. She experienced associated neurogenic bladder and self catheterized daily at home. She additionally presented with a chronic stage 3 sacral ulcer due to decreased sacral/perianal sensation.

Setting: Tertiary-care teaching hospital

Assessment/Results: Imaging demonstrated a right femoral neck fracture and she underwent right hip hemiarthroplasty. She was admitted to acute inpatient rehabilitation, at which time she ambulated 10 feet with a walker and maximal assistance. By discharge 3 weeks later, she ambulated 125 feet with a walker and supervision. She was trained to resume her prior self catheterization, and her sacral ulcer improved with daily wound care and a pressure relief mattress.

Discussion (relevance): sdAVF are the most common form of exceedingly rare spinal vascular lesions. sdAVF lesions are complex and have variable architecture, with some studies suggesting they are fed by the spinal radicular artery. Presentation involves progressive neuropathic and myelopathic manifestations secondary to anatomic distortion. Diagnosis involves MRI and/or angiogram. Treatment options include open surgical ligation or endovascular embolization.

Conclusions: The progression of our patient’s neuropathic and myelopathic symptoms secondary to her sdAVF brought about a fall with hip fracture. She faced an uphill battle with baseline left lower extremity weakness and new right lower extremity weakness secondary to her fracture, however she gained functional improvement with acute inpatient rehabilitation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-fall-with-a-hip-fracture-in-a-patient-with-a-rare-thoracic-spinal-dural-arteriovenous-fistula/