1101 - Uncommon Age, Uncommon Site: Multidisciplinary Rehabilitation of Craniocervical SDAVF in a Young Adult

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SW

Sunil K. Wadhwa, MD

Physical Medicine and Rehabilitation Resident Physician
The Wright Center
Scranton, Pennsylvania, United States

Co-Author(s)

AS

Alex Sophabmixay, BS

Medical Student
Philadelphia College of Osteopathic Medicine
Philadelphia, Pennsylvania, United States
MW

Michael Wolk, MD

Associate Program Director
The Wright Center for Graduate Medical Education
Scranton, Pennsylvania, United States

Submitter(s)

SW

Sunil K. Wadhwa, MD

Physical Medicine and Rehabilitation Resident Physician
The Wright Center
Scranton, Pennsylvania, United States

Case Diagnosis:
Spinal dural arteriovenous fistula (SDAVF) at the craniocervical junction, presenting as rapidly progressive myelopathy with severe gait impairment, spasticity, and neurogenic bladder and bowel dysfunction, complicated by autonomic dysreflexia in a 22-year-old male.

Case Description: A previously healthy young man developed subacute, progressive lower extremity weakness, spasticity, and sphincter dysfunction over five months, culminating in severe gait impairment and dependence on assistive devices. MRI revealed longitudinally extensive T2 hyperintensity and perimedullary flow voids, and digital subtraction angiography confirmed a SDAVF supplied by the V3 segment of the left vertebral artery. The patient underwent successful endovascular embolization, followed by comprehensive inpatient rehabilitation. During rehabilitation, he required intensive spasticity management, transfer and mobility training, and education on neurogenic bladder and bowel care. He experienced recurrent autonomic dysreflexia, which improved with optimized bladder and bowel regimens and patient/caregiver education. At discharge, he achieved independence in wheelchair mobility and activities of daily living, and was able to ambulate with modified assistive devices.

Discussions: SDAVF is the most common spinal vascular malformation, but remains rare in young adults and can present with insidious, progressive myelopathy with significant functional deficits. Early diagnosis is critical to prevent irreversible deficits. Digital subtraction angiography remains the gold standard for diagnosis and localization. Both surgical and endovascular treatments are effective, with high rates of radiological cure and functional improvement when performed promptly. Neurorehabilitation is essential for maximizing recovery, addressing spasticity, assistive device training for mobility and ambulation, managing neurogenic bladder and bowel, and preventing secondary complications such as autonomic dysreflexia. Patient and caregiver education is vital for long-term management and psychosocial adaptation, especially in younger patients.

Conclusions: This case highlights the importance of early recognition and multidisciplinary management of rarely seen SDAVF in young adults. Integration of neurorehabilitation, management of complications, and individualized education is essential for optimizing functional outcomes and quality of life.