Congestive myelopathy due to cervical perimedullary arteriovenous fistula evaluated by apparent diffusion coefficient values - case report.
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.
Inoue
Tomoo
T
Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan.
Takahashi
Toshiyuki
T
Shimizu
Hiroaki
H
Matsumoto
Yasushi
Y
Takahashi
Akira
A
Tominaga
Teiji
T
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