Weakness in Both Legs

23-year-old patient presents with weakness in both legs.

Figure 1A. MRI showed vascular mass at D11, and D12 level seen measuring  50 mm (CC) × 18 mm (AP) containing tortuous vessels. Mass is also seen involving D12 vertebral body resulting in marrow edema of D12.

Figure 1B. MRI showed vascular mass at D11, and D12 level seen measuring 50 mm (CC) × 18 mm (AP) containing tortuous vessels. Mass is also seen involving D12 vertebral body resulting in marrow edema of D12.

Figure 1C. MRI showed vascular mass at D11, and D12 level seen measuring 50 mm (CC) × 18 mm (AP) containing tortuous vessels. Mass is also seen involving D12 vertebral body resulting in marrow edema of D12.

Figure 1D. MRI showed vascular mass at D11, and D12 level seen measuring 50 mm (CC) × 18 mm (AP) containing tortuous vessels. Mass is also seen involving D12 vertebral body resulting in marrow edema of D12.

Figure 1E. MRI showed vascular mass at D11, and D12 level seen measuring 50 mm (CC) × 18 mm (AP) containing tortuous vessels. Mass is also seen involving D12 vertebral body resulting in marrow edema of D12.

Figure 2A. Intradural, extraspinal, and extradural component of AVM.

Figure 2B. Intradural, extraspinal, and extradural component of AVM.

Figure 3. MR myelography shows thecal sac compression by mass.

Diagnosis: Spinal arteriovenous malformation (AVM)

DSA angiography remains the investigation of choice, but requires meticulous technique.

Spinal arteriovenous malformations (AVMs) are characterized by arteriovenous shunting with a true nidus.

Spinal AVMs may be classified as intramedullary and extramedullary.