Presentation
Left hand and foot pain.
Patient Data
Dilated anterior spinal artery and prominent paraspinal veins. The TRICKS study demonstrates suggests a dural AVF in the lower cervical spine as the underlying cause for the arterial and venous prominence on other sequences.
At the mid thoracic level CSF density impresses upon the dorsal aspect of the cord. CSF remains present anterior to the cord at this level and on axial imaging flattening of the posterior aspect of the cord is seen. A small cord syrinx is seen in association. Appearance is consistent with the scalpel sign of dorsal thoracic arachnoid web with associated syrinx.
Case Discussion
This is a complicated case, and highlights the failure of Occam's razor in some instances, namely that trying to fit both findings (vessel in the cervical region, and thoracic changes) into one diagnosis is difficult and leads to overly complicated hypotheses. Rather, accepting dual pathology makes arriving at each diagnosis relatively easy, namely cervical dural arteriovenous fistula and dorsal thoracic arachnoid web with scalpel sign.