title: [A 68-year-old man of dural arteriovenous fistula at the cranio-cervical junction with dysesthesia ascending from his both toes].
abstract: We reported a 68-year-old man of dural arteriovenous fistula at the cranio-cervical junction with dysesthesia ascending from his both toes. He recognized dysesthesia at his both toes 10 months previously. Thereafter dysesthesia ascended to his girdle which was stronger as far as his girdle and gait disturbance developed. Somatosensory evoked potential (SEP) revealed delayed central conduction time. Cervical MRI showed a swelling of the spinal cord and intramedullary hyperintense lesion from the C2 to C7 level on the T2-weighted image. Moreover flow void behind the mudulla oblongata on the T2-weighted MRI was outstanding. Angiogram through right ascending pharyngeal artery revealed enlarged and tortuous anterior and posterior spinal veins at the early arterial phase. We diagnosed as dural arteriovenous fistula (AVF) and conducted intraarterial embolization. After treatment, the swelling and hyperintense lesion of the cervical spinal cord improved on MRI, and flow void behind medulla oblongata was extinguished. Gait disturbance also improved. We think that the valves of veins in the spinal cord are responsible for the tendency of higher venous pressure in outer circumference, which results in the symptom dominating in the lower extremities. We recommend that dural AVF at the cranio-cervical junction should be considered as a differential diagnosis in case with the similar clinical course to our case.
authors.affiliation: Department of Neurology, International Medical Center of Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kobessho
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Uesaka
authors.forename: Masaki
authors.initials: M
authors.lastname: Nishimiya
authors.forename: Kanehiro
authors.initials: K
authors.lastname: Hasuo
authors.forename: Masanari
authors.initials: M
authors.lastname: Kunimoto
mesh_terms: D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D009333:Neck; D010292:Paresthesia / Q000209:etiology*; D014034:Toes / Q000294:innervation*