Disclosures: Amanpreet Saini, MD: No financial relationships or conflicts of interest

Case Description: The patient was an 87-year-old male with past medical history of hypertension, stage 4 prostate cancer who presented to the emergency department with progressive weakness in his bilateral lower extremity and urinary incontinence over the course of 6 months. Imaging obtained showed thoracic edema with obvious dilated vessels dorsal to the cord. A spinal angiogram demonstrated a dural AV fistula at the level of T10. Consequently, the patient underwent microsurgical intervention for a T10 spinal dural AV fistula disconnection. He was stabilized and after surgery required 2-person assistance with bed mobility and sit to stand transfers due to continued weakness. He was transferred to an acute inpatient rehabilitation hospital, where he improved in his lower extremity strength.

Setting: Academic Acute Inpatient Rehabilitation Hospital

Patient: An 87-year-old male with non-traumatic spinal cord injury due to spinal dural arteriovenous (SDAVF) fistula Assessment/

Results: The patient demonstrated improvement in balance and endurance as shown by an increase in stand pivot transfers from maximum assistance to minimum assistance. He had improved sit to stand to moderate assistance and supine to sit to moderate assistance. The acute inpatient rehabilitation team educated him on changes after a spinal cord injury such as neurogenic bladder and bowel.

Discussion: SDAVF is a rare cause of vascular-related non-traumatic spinal cord injury. Patients typically have a slow progression of weakness over the course of several months that can be accompanied by bladder or bowel incontinence. These vague symptoms can cause a significant delay in the diagnosis and surgical treatment, leading to a poor prognosis.

Conclusion: This case demonstrates not only how imperative a prompt diagnosis is, but also the importance of integrating acute inpatient rehabilitation to improve function. To our knowledge, there are only a few documented cases incorporating a physiatrist’s role in this setting.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2020

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-lower-extremity-weakness-due-to-spinal-dural-arteriovenous-fistula-a-case-report/