Sudden paraplegia after lumbar puncture as a clue in the diagnosis of a patient with spinal dural arteriovenous fistula.

Abstract

Spinal dural arteriovenous fistula (SDAVF) is manifested as congestive myelopathy with progressive motor, sensory and urinary symptoms. Sometimes, clinical picture and magnetic resonance imaging of the spinal cord are not specific and the diagnosis becomes troublesome. We present a 68-year-old male with a progressive paraparesis of unknown etiology over the course of 12 months. Immediately after LP, the patient remarked a sudden worsening in muscular balance of his inferior limbs and a worsening of urinary retention. This fact was the clue to the SDAVF diagnosis. SDAVF was totally resolved after surgical treatment. During next months, paraplegia slightly improved and he is currently receiving rehabilitation treatment. Acute paraplegia or sudden worsening of previous symptoms secondary to decreasing in cerebrospinal fluid pressure after lumbar puncture has been described, so physicians should be aware of this dramatic and avoidable complication.