Intracranial dural arteriovenous fistula showing diffuse MR enhancement of the spinal cord: case report and review of the literature.
BACKGROUND
Cervical myelopathy resulting from intracranial dural arteriovenous fistula (AVF) is uncommon. Knowledge of the magnetic resonance imaging (MRI) appearance of such lesions is important because many patients with myelopathy are initially examined by MRI, and an incorrect diagnosis could result in delayed or improper treatment. We describe a rare case of myelopathy due to an intracranial dural AVF showing diffuse enhancement of the cervical spinal cord.


METHODS
A 64-year-old male presented with progressive myelopathy and respiratory insufficiency. Cerebral angiography disclosed an AVF at the craniocervical junction draining intrathecally into the spinal medullary veins. MRI revealed dilated perimedullary vessels around the craniocervical junction, as well as spinal cord swelling with high signal intensity changes. Diffuse intense enhancement of the cervical spinal cord was also seen on postcontrast images. Embolization via the afferent artery was successfully performed, and the fistula was then microsurgically obliterated via a lateral suboccipital approach. This procedure arrested a rapidly progressive myelopathy.


CONCLUSIONS
Intracranial dural AVF showing diffuse enhancement of the spinal cord is extremely rare, and this enhancement effect may indicate pathologic changes of the spinal cord. MRI only is not useful for diagnosis, but also for demonstrating pathologic changes and predicting the outcomes of patients with intracranial dural AVF.
Asakawa
Hiroyuki
H
Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Yanaka
Kiyoyuki
K
Fujita
Keishi
K
Marushima
Aiki
A
Anno
Izumi
I
Nose
Tadao
T
D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000601:surgery; D003131:Combined Modality Therapy; D003399:Craniotomy; D004388:Dura Mater / Q000098:blood supply* / Q000473:pathology; D004621:Embolization, Therapeutic; D006801:Humans; D007089:Image Enhancement; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D013116:Spinal Cord / Q000098:blood supply* / Q000473:pathology; D014680:Veins / Q000473:pathology / Q000601:surgery; D014690:Venous Pressure / Q000502:physiology