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304 North Cardinal St.
Dorchester Center, MA 02124

Subacute Leg Pain, Numbness, And Weakness


Consult Page

61F with bilateral lower extremity pain and weakness, MRI showing possible fistula

Initial Imaging

Fig. 43.1, T2-weighted sagittal MRI of the thoracic spine shows dorsal perimedullary flow voids (blue arrow) concerning for a dural arteriovenous fistula. There is also T2 hyperintensity in the cord likely from associated edema (yellow arrow). Incidental hemangiomas are seen within multiple vertebral bodies.

Walking Thoughts

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    What is the patient’s neurological exam?

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    Is the patient weak, or is her weakness pain limited?

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    What is the timeline of her symptoms?

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    Where is the fistula on MRI? Do the patient’s symptoms localize to the site of the lesion seen on MRI?

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    Is there any acute decompensation suggestive of acute hemorrhage, or are her symptoms more gradual due to spinal cord dysfunction from alteration in vascular flow dynamics?

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    Does the patient need further imaging?

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    Does the patient need surgery? What is the timing of surgery?

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    Does the patient take any antiplatelet or anticoagulant medications?

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