The problem of arteriovenous malformations of the spinal cord in the elderly: Case report of an octogenarian

Arteriovenous malformations (AVMs) of the spinal cord pose a serious diagnostic challenge for the clinician. Their clinical picture may mimic multiple sclerosis, anterior spinal cord syndrome, spinal cord infarction, neoplastic compression or spondylosis. They are typical in senior adults and tend to be localized in the thoraco-lumbar cord. Their clinical course varies, even though they tend to have a gradual onset and progression. Patients present with fluctuating and deterioration of neurological function, consisting of a combination of spastic paraparesis, sphincter dysfunction and loss of sensation. of various degree in the lower extremities. The case reported, an 82 year old female, confirms the difficulty of establishing the diagnosis of AVMs, and, the necessity of promptly resorting to Magnetic Resonance (MR) and spinal angiography to avoid further complications. Unfortunate1y, clear guidelines for a diagnostic work up do not exist, particulary in the very aged.