title: Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula.
abstract: Intracranial dural arteriovenous fistula (dAVF) usually results in various problems in the brain. But it can be presented as a myelopathy, which may make early diagnosis and management to be difficult. We recently experienced a case of cervical myelopathy caused by intracranial dAVF. A 60-year-old man presented with a 3-year history of gait disturbance due to a progressive weakness of both legs. Neurological examination revealed spastic paraparesis (grade IV) and Babinski sign on both sides. Magnetic resonance imaging showed serpentine vascular signal voids at C2-T1 on T2-weighted image with increased signal intensity and swelling of spinal cord at C1-C4. We performed a brain computed tomography angiography and found intracranial dAVF with multiple arteriovenous shunts. Venous drainages were noted at tentorial veins and cervical perimedullary veins. After Onyx embolization, the patient showed gradual improvement in motor power and gait disturbance. The venous drainage pattern is a well-known prognostic factor of dAVF. In our case, the intracranial dAVF drained to spinal perimedullary vein, which seemed to result in the ischemic myelopathy. Although it is rare condition, it sometimes can cause serious complications. Therefore, we should keep in mind the possibility of intracranial dAVF when a patient presents myelopathy.
authors.affiliation: Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Jin Bum
authors.initials: JB
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Taek Kyun
authors.initials: TK
authors.lastname: Nam
authors.affiliation: Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Young Baeg
authors.initials: YB
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Seung Won
authors.initials: SW
authors.lastname: Park
keywords: Arteriovenous fistula; Brain; Ischemia; Spinal cord diseases