Korean J Spine.  2016 Jun;13(2):67-70. 10.14245/kjs.2016.13.2.67.

Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula

• Kim WY
• Kim JB
• Nam TK
• Kim YB
• Park SW

• KMID: 2328334
• DOI: http://doi.org/10.14245/kjs.2016.13.2.67

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.

Keyword

Brain; Arteriovenous fistula; Ischemia; Spinal cord diseases

MeSH Terms

Angiography
Arteriovenous Fistula
Brain
Central Nervous System Vascular Malformations*
Drainage
Early Diagnosis
Gait
Humans
Ischemia
Leg
Magnetic Resonance Imaging
Middle Aged
Neurologic Examination
Paraparesis, Spastic
Reflex, Babinski
Spinal Cord
Spinal Cord Diseases*
Spinal Cord Ischemia
Veins