|Year : 2016 | Volume
| Issue : 3 | Page : 355-356
Spinal arteriovenous malformation presenting with urinary retention
Department of Urology, James Paget University Hospital, Gorleston-on-Sea, Great Yarmouth, Norfolk, NR31 6LA, United Kingdom
|Date of Web Publication||29-Jun-2016|
Department of Urology, James Paget University Hospital, Lowestoft Road, Gorleston.on.Sea, Great Yarmouth, Norfolk, NR31 6LA
| Abstract|| |
We present a case of a young female patient presenting predominantly with recurrent episodes of urinary retention. Extensive urological workup was unremarkable. There were some subtle and long-standing neurological findings which prompted us to investigate further with a spinal magnetic resonance imaging scan. The scan demonstrated a spinal arteriovenous malformation (AVM) beginning from the L4/L5 level to the S1/S2 level. Spinal AVM can be a rare cause of urinary retention, and we would like to highlight the importance of having that in the list of our differential when other more common causes have been excluded, and the patient remains symptomatic.
Keywords: Spinal arteriovenous malformation, spinal magnetic resonance imaging scan, urinary retention
|How to cite this article:|
Vrettos A. Spinal arteriovenous malformation presenting with urinary retention. Urol Ann 2016;8:355-6
| Introduction|| |
Urinary retention is one of the most common urology emergencies. A variety of pathologies can be responsible for the development of urinary retention such as outflow obstruction, neurologic impairment, urinary tract infection, medications, and trauma. Spinal arteriovenous malformations (AVMs) can be a rare neurological cause of urinary retention.
| Case Report|| |
An 18-year-old woman presented with recurrent episodes of urinary retention and urinary tract infections for the last 2 months. The patient also complained of mild chronic lower back pain, pain affecting the posterolateral right thigh and an on-and-off tingling sensation on the dorsal surface of her right foot and toes. The rest of the neurological examination was normal without any motor weakness. The patient was not on any medications, and there was no relevant past medical history. A full blood count, urea, electrolytes, creatinine, and inflammatory markers were all within normal limits. The urological examination, an abdominal ultrasound scan, and a flexible cystoscopy were all unremarkable. Given the combination of neurological and urological symptoms, a contrast brain and spinal magnetic resonance imaging (MRI) scan was deemed to be appropriate. The brain MRI scan was unremarkable, but the spinal images revealed an anterior AVM beginning from the L4/L5 level to the S1/S2 level [Figure 1]. Spinal AVM can rarely present with bladder dysfunction, and a high degree of suspicion is necessary to establish the diagnosis. Neurosurgical consultation is of outmost importance in these cases but, unfortunately, the patient has refused any intervention at the moment and is managed with intermittent self-catheterization.
|Figure 1: Sagittal view of the spinal magnetic resonance imaging scan which shows an anterior epidural arteriovenous malformation at L4/5 to S2 level (arrow). The thecal canal is obliterated at S1/2 level|
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| Discussion|| |
Spinal AVMs are rare abnormalities of the vasculature which can present with a combination of neurological symptoms including back pain, paresthesias, and lower limbs weakness. These lesions consist of an abnormal connection between the normal arterial and venous system. The clinical symptoms arise from alterations in blood flow resulting in spinal cord ischemia. To our knowledge, this is the second case in the literature which describes a patient with a spinal AVM presenting predominantly with urinary retention. Spinal AVMs should be in the differential list for the patients presenting with otherwise unexplained episodes of urinary retention, which might initially challenge the physician's diagnostic reasoning. We would like to highlight the importance of performing a complete neurological examination and appropriate radiological investigations (i.e., MRI scan) to establish the right diagnosis.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Hussain IF, Taylor W, Mundy AR, Fowler CJ. Acute urinary retention: An unusual presentation of a spinal arteriovenous malformation. BJU Int 1999;83:1079-80.
Aminoff MJ, Logue V. Clinical features of spinal vascular malformations. Brain 1974;97:197-210.