Spinal dural arterio-venous fistula
Progressive back and lower limb pain with dysesthesia of the thighs.
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Swollen, edematous conus associated with multiple serpentine intra-thecal filling defects showing flow voids. Note following contrast injection there is patchy enhancement of the conus (arrow).
These dural AVF are usually spontaneous and incidentally found on MRI of the spine for back pain or lower limb neurological symptoms. They cause symptoms from venous congestion of the cord parenchyma due to the arterialization of dural veins draining the spinal cord.