Toddler with Progressive Lower Extremity Weakness

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Dural arteriovenous fistulas (DAVFs) account for nearly 85% of all spinal vascular malformations as the most common subtype, with a typical diagnosis timeline in the 5th or 6th decade of life. Younger patients (< 30 years old) account for less than 1% of patients with DAVFs. DAVFs are extremely rare in the pediatric population, with other subtypes like spinal cord AVMs and perimedullary AVMs being more common. The gold standard imaging for diagnosis is spinal digital subtraction angiography, however MRI is typically used for initial visualization. Long term follow up is important, as patients under the age of 18 have a recurrence rate between 5.5% and 17.5%. This exhibit follows a pediatric patient with an acute neurologic presentation of symptoms secondary to a spinal DAVF.

A 13 m.o. previously healthy male presented to the ED with a 2-week history of progressive lower limb weakness. The patient, who was previously walking regularly, began to display a disinterest in doing so, made fewer attempts to roll over or sit up without assistance, crawled using only his arms and was notably fussier and uncomfortable. There is no known trauma, recent illnesses, fevers, or abnormal eye or upper extremity movements. The patient was unvaccinated. Physical exam revealed tenderness to palpation of the thoracic spine, patellar and Achilles hyperreflexia patellar and Achilles with clonus on left, and spastic hypertonia of the lower extremities. Vital signs and laboratory data were unremarkable.

Spinal vascular malformations are a rare diagnosis in the pediatric population; DAVFs are exceptionally rare. Consideration of this diagnosis in acute onset neurological symptoms in the pediatric population is essential to prompt identification and treatment to prevent further damage along with adequate follow-up to monitor for recurrence.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1998

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