title: Positional vomiting due to a thoracic spinal dural arteriovenous fistula. Case report.
abstract: The authors report the unique case of a patient with a thoracic spinal dural arteriovenous fistula (DAVF) causing remote brainstem symptoms of positional vomiting and minimal vertigo. Magnetic resonance (MR) imaging of the brain demonstrated high signal abnormality in the medulla, presumably related to venous hypertension, and spinal MR imaging revealed markedly dilated veins along the dorsal aspect of the cord. Spinal angiography confirmed the presence of a thoracic spinal DAVF. Disconnection of the DAVF from the spine resulted in a marked improvement in symptoms and resolution of the preoperative MR imaging-documented abnormalities. The authors highlight the rare syndrome of positional vomiting as a brainstem symptom and conclude that spinal DAVFs should be considered in the differential diagnosis of high signal MR imaging abnormalities localized to the brainstem.
authors.affiliation: Southern Neurology and Mayne Health Radiology, St. George Private Hospital, Kogarah, New South Wales, Australia. dcordato@southern-neurology.com.au
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Cordato
authors.forename: Mark A
authors.initials: MA
authors.lastname: Davies
authors.forename: Lynette T
authors.initials: LT
authors.lastname: Masters
authors.forename: Phillp D
authors.initials: PD
authors.lastname: Cremer
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Schwartz
authors.forename: William
authors.initials: W
authors.lastname: Sorby
authors.forename: Zoran
authors.initials: Z
authors.lastname: Becvarovski
mesh_terms: D000792:Angiography; D001164:Arteriovenous Fistula / Q000150:complications*; D004388:Dura Mater / Q000098:blood supply*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply; D008875:Middle Aged; D011187:Posture; D013904:Thoracic Vertebrae / Q000098:blood supply*; D014690:Venous Pressure / Q000502:physiology; D014717:Vertigo / Q000209:etiology; D014839:Vomiting / Q000209:etiology*