We present a case of magnetic resonance imaging (MRI)-occult intracranial dural arteriovenous fistula (DAVF) with serious cervical myelopathy and review the pathophysiological background.
Summary of case
A 61-year-old man had suffered from progressive neurological deterioration. He had demonstrated swollen spinal cord with diffuse enhancement and no dilated vascularity on MRI. Finally, digital subtraction angiography revealed DAVF at the petrous ridge and it was successfully treated by embolization.
Conclusion
A slow flow DAVF is not readily recognizable on MRI. Whenever a patient presents with unexplainable progressive myelopathy, a possibility of vascular origin has to be considered.
BordenJAWuJKShucartWA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg1995; 82: 166–179.
2.
CognardCGobinYPPierotL. Cerebral dural arteriovenous fistulas: cCinical and angiographic correlation with a revised classification of venous drainage. Radiology1995; 194: 671–680.
3.
AsakawaHYanakaKFujitaK. Intracranial dural arteriovenous fistula showing diffuse MR enhancement of the spinal cord: Case report and review of the literature. Surg Neurol2002; 58: 251–257.
4.
BoussonVBrunereauLVahediK. Intracranial dural fistula as a cause of diffuse MR enhancement of the cervical spinal cord. J Neurol Neurosurg Psychiatry1999; 67: 227–230.
HahnelSJansenOGeletnekyK. MR appearance of an intracranial dural arteriovenous fistula leading to cervical myelopathy. Neurology1998; 51: 1131–1135.
7.
ThiexRMayfrankLKringsT. Delayed diagnosis of spinal dural arteriovenous fistula in the absence of pathological vessels on MRI. Zentralbl Neurochir2006; 67: 94–98.
8.
MorrisJMKaufmannTJCampeauNG. Volumetric myelographic magnetic resonance imaging to localize difficult-to-find spinal dural arteriovenous fistulas. J Neurosurg Spine2011; 14: 398–404.
9.
MillerTREskeyCJMamourianAC. Absence of abnormal vessels in the subarachnoid space on conventional magnetic resonance imaging in patients with spinal dural arteriovenous fistulas. Neurosurg Focus2012; 32: E15.
10.
LasjauniasPMaillotCTerbruggeK. Pial relations with spinal cord veins explain MRI occult spinal AV shunts. Interv Neuroradiol2000; 6: 333–336.
11.
MitsuhashiYAurboonyawatTPereiraVM. Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: Possible homologs of spinal dural arteriovenous fistulas. Clinical article. J Neurosurg2009; 111: 889–899.
