Spinal dural arteriovenous fistula

Case contributed by A.Prof Frank Gaillard

Presentation

Progressive paraparesis, and sphincter problems.

Patient Data

Age: 50 years
Gender: Male

The conus and lower thoracic cord demonstrate increased T2 signal centrally without a convincing mass or focal region of abnormal enhancement, although the entire region demonstrates faint enhancement. Along the dorsal aspect of the cord numerous tortuous filling defects are demonstrated, best seen on the sagittal T2 images. 

Annotated image

The conus and lower thoracic cord (from T9/10) demonstrate increased T2 signal centrally (blue arrows). Along the dorsal aspect of the cord numerous tortuous filling defects are demonstrated (red arrows). 

DSA (angiography)

There are two areas of arteriovenous shunting filling from nerve root sheath to perimedullary veins.  

The highest flow is from the right third intercostal. The drainage from this level was into tortuous perimedullary veins around the cervical and upper thoracic cord.

A second separate focus of spinal dural arteriovenous fistula filled from a right sixth intercostal branch, with drainage being preferentially inferiorly into distended perimedullary veins.

Annotated image

Early (left) and late (right) images of each level of fistula formation demonstrates the fistula (F) the intercostal artery (IC) and dilated perimedullary veins (PMV). 

Case Discussion

Typical appearances of a spinal dural arteriovenous fistula, demonstrating the need to complete a full spinal angiogram as not only can the source be distant form the clinical and MRI abnormality but multiple fistulae may be present. 

Case courtesy of A/Prof Peter Mitchell, Royal Melbourne Hospital. 

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Case information

rID: 19594
Case created: 27th Sep 2012
Last edited: 4th Nov 2015
Tag: spine
Inclusion in quiz mode: Included

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