Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
September 2014
Next Case of the Month coming October 7 . . .
Craniovertebral Junction Dural Arteriovenous Fistula
- Spinal dural arteriovenous fistulas (DAVFs) in the cervical spine are relatively rare.
- Clinical Presentation: DAVF symptoms are related to the cord level involved: impotence and bowel/bladder dysfunction in distal (thoracic-lumbar) fistulas; extremity weakness and sensibility alterations in cervical cord involvement; altered function of cranial nerves and motor dysfunction in upper cervicomedullary fistulas.
- Key Radiologic Features:
- Noncontrast CT: Edema within the cord
- MRI: Hyperintense signal on T2WI within an enlarged cord, and prominent flow voids along the cord surface. Contrast administration confirms the presence of dilated pial plexus of veins.
- CE MRA helps in diagnosis, showing the feeding artery, but DSA is the gold standard for depicting fistula, the feeding arteries, and the type of draining veins.
- DDx:
- Transverse myelitis
- Low-grade intra-axial tumor
- Ischemia
- Rx:
- Vascular embolization
- Surgical clipping