Clinical judgement and decision making in clinical practice. A free spirit with imminent paraplegia

A 45-year-old man was admitted because of loss of strength in the legs and urinary retention. MRI showed enlargement of the thoracic and lumbar spinal cord from T11 to the conus medullaris. Magnetic resonance angiography and spinal angiography showed a dural arteriovenous fistula. The abnormal connection was clipped surgically after which the patient recovered fully