Spinal dural arteriovenous fistulae are the most common vascular malformation of the spinal cord. Patients typically present with slowly progressive myelopathy that is often wrongly diagnosed as degenerative cervical or lumbar stenosis. Spinal magnetic resonance imaging showing cord hyperintensity with associated flow voids posteriorly is pathognomonic. Definitive diagnosis and localization are achieved with spinal angiography. Treatment options include endovascular embolization and surgical ligation with good results. We present here a 46-year-old gentleman with acute paraplegia secondary to a thoracic dural arteriovenous fistula. He was treated with surgical management with improvement in symptoms. We aim to highlight the importance of early diagnosis and management of this potentially treatable condition.
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