A 59 year old man presented with progressive numbness and weakness in the lower extremities over a month. He developed gradual numbness and shooting pain radiating down to his feet after a 15 hour flight. He then went on an 8 hour long flight, after which he was unable to urinate and had a urinary catheter placed. When he arrived in NY, he was found to have a herniated disc at L4-L5. The urinary catheter was removed and he was given a methylprednisolone dose pack with minimal improvement. He flew to New Mexico and afterwards was unable to move his left toes. He then flew to Oregon and by the time he arrived back to NY, the weakness progressed up to the left knee and he was unable to walk.

MRI Thoracic spine with contrast showed longitudinally extensive abnormal signal from T6 to the conus medullaris.

MR Angiography of the Spinal Cord showed a spinal dural AVF at the T12-L1 level.

He underwent L1 laminectomy, T12 and L2 hemilaminectomy, intradural coagulation and resection of the AVF. He regained sensation and some motor function in the lower extremities prior to discharge.

Clinical manifestations of spinal dural AVF may be exacerbated by prolonged air travel, perhaps due to changes in atmospheric pressure. A high index of suspicion must be maintained for anyone who develops myelopathic symptoms, especially when associated with changes in atmospheric pressure such as prolonged flights. Earlier recognition and treatment of spinal dural AVF may result in improved long-term outcome.