• Sarah I Sheikh, Katharina M Busl, MingMing Ning, and Nagagopal Venna.
• Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
• J Emerg Med. 2011 Dec 1; 41 (6): e137-40.

BackgroundInitially described in 1926, spinal dural arteriovenous fistula remains diagnostically challenging. Presenting symptoms are often common complaints in general practice or the emergency department, such as leg weakness or numbness. One of the less recognized early features is that of sphincteric disturbance.ObjectivesTo elucidate the underappreciated early feature of urinary sphincter disturbance in spinal arteriovenous fistula.Case ReportWe report on 2 patients with early urinary symptoms that mimicked obstructive uropathy, both of whom sought medical attention on several occasions before the diagnosis was reached. The clinical and imaging findings of spinal dural fistula are discussed.ConclusionAtypical presentations of bladder dysfunction in addition to other neurologic complaints in the appropriate patient population should prompt spinal imaging to exclude a spinal dural fistula. Timely diagnosis and treatment can prevent the progression of spinal cord edema to infarction with paraparesis, and permanent bladder and bowel dysfunction.Copyright © 2011 Elsevier Inc. All rights reserved.

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