title: Congestive myelopathy due to cervical perimedullary arteriovenous fistula evaluated by apparent diffusion coefficient values - case report.
abstract: A 22-year-old woman presented with a cervical perimedullary arteriovenous fistula (AVF) manifesting as right upper and lower extremity weakness. T2-weighted magnetic resonance (MR) imaging showed intramedullary hyperintensity believed to be caused by venous congestion. Preoperative diffusion-weighted MR imaging showed increased apparent diffusion coefficient (ADC) value. Spinal angiography demonstrated an AVF fed mainly by the right C-5 radicular artery. Complete obliteration of AVF was achieved by endovascular embolization and microsurgical shunt occlusion. The ADC value was normalized and her neurological deficits improved after endovascular surgery, whereas T2-weighted MR imaging still demonstrated the lesion. The high preoperative ADC value probably indicated reversible vasogenic edema and immediate normalization of the ADC value suggests a good clinical outcome.
authors.affiliation: Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Inoue
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Akira
authors.initials: A
authors.lastname: Takahashi
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D002574:Cervical Vertebrae; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods / Q000592:standards; D004487:Edema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D008833:Microcirculation / Q000002:abnormalities / Q000473:pathology / Q000503:physiopathology; D008866:Microsurgery; D010291:Paresis / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology; D013116:Spinal Cord / Q000098:blood supply* / Q000473:pathology* / Q000503:physiopathology; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D020760:Spinal Cord Ischemia / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D013346:Subarachnoid Space / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome