A Case of Dural Arteriovenous Fistula at the Craniocervical Junction with High Signal Intensity Localized to the Thoracic Spinal Cord on T2-weighted MRI Kei SATO 1 , Yoichi MOROFUJI 1 , Eisaku SADAKATA 1 , Nobutaka HORIE 1 , Tsuyoshi IZUMO 1 , Takeo ANDA 1 , Takayuki MATSUO 1 1Department of Neurosurgery, Nagasaki University School of Biomedical Science Keyword: dural arteriovenous fistula , craniocervical junction , myelopathy , craniocervical junction dural arteriovenous fistula pp.245-251
Published Date 2020/3/10
DOI https://doi.org/10.11477/mf.1436204170
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 An 82-year-old man presented with lower extremity weakness, paresthesia, and gait disturbance. At the previous hospital, spinal MRI had demonstrated a high-intensity area confined to the thoracic spinal cord on T2-weighted images and prominent dorsal venous flow voids that were suggestive of a thoracolumbar dural arteriovenous fistula(dAVF).

 Spinal digital subtraction angiography(DSA)failed to detect the shunt point. MRDSA of the head revealed a dAVF at the craniocervical junction(CCJ). Cranial DSA demonstrated feeders from the left vertebral artery and left radicular artery, a shunting point on the dura at the CCJ, and drainers into the anterior and posterior spinal veins descending to the sacral level. Surgery improved his symptoms, and the abnormal imaging findings were resolved.

 Observation of a dAVF at the CCJ with myelopathy is rare, and the diagnosis of this type of dAVF might be challenging. MRDSA might be a useful tool for detecting this uncommon dAVF.

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