Spinal dural arteriovenous fistula
Low back pain, lame. Numbness in lower extremities. The patient feels progression in symptoms in last 2 years.
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Expansion and T2 hyperintensity of the lower thoracic and lumbar spinal cord. Prominent T2 signal voids within the thecal sac.
Spinal dural arteriovenous fistulae (SDAVF) are rare but are still the most common type of spinal vascular malformation. Veins are low pressure and low flow structures, so when a fistula forms blood from an artery under a high pressure goes directly into a vein causing venous hypertension and congestion of the cord with edema resulting in cord expansion and T2 hyperintensity. The etiology is unknown. The best sequence to depict the extent of SDAVFs without using intravenous contrast agent is gradient-echo 3D ciss (constructive interference in steady state) sequences.
- Hingwala D, Chatterjee S, Kesavadas C, Thomas B, Kapilamoorthy TR. Applications of 3D CISS sequence for problem solving in neuroimaging. The Indian journal of radiology & imaging. 21 (2): 90-7. doi:10.4103/0971-3026.82283 - Pubmed
- Spinal Dural Arteriovenous Fistula (SDAVF). (n.d.). Retrieved November 16, 2016, from http://www.med.nyu.edu/radiology/about-us/subspecialties/neuro-interventional/our-services/spinal-dural-arteriovenous-fistula