Intracranial dural av fistula with spinal perimedullary venous drainage rare case
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A 26-year-old male presented with gradually worsening quadriparesis over 3 weeks and decreased respiratory drive over 2 days. MRI showed cord swelling and central hyperintensity on T2 images, resembling central grey matter. Contrast MRI showed dilated enhanced perimedullary veins on the spinal cord surface. The final diagnosis was an intracranial DAVF fed by the meningohypophyseal trunk and middle meningeal artery with spinal perimedullary venous drainage. Treatment with occlusion of the fistula using Onyx liquid embolic agent was planned.
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Intracranial dural av fistula with spinal perimedullary venous drainage rare case
- 1. Section of Interventional & Neuroradiology GGMC & Sir JJ Hospital, Byculla, Mumbai Dr. Prashant Pote (JR2) Dr. Avinash Gutte (Asst. Prof)
- 2. 26 yrs/M---- From Neurology C/o gradual but rapidly progressive quadreparesis since 3 weeks. C/o Decreased respiratory drive since 2 days. No past major illness.
- 3. MRI T2 images showing cord swelling central hyperintensity taking the shape of the central grey matter
- 4. After contrast injestion, dilated enhanced perimedullary veins were observed on the surface of the spinal cord
- 5. MRI interpretation… DDx SPINAL DAF INTRAMEDULARY AVM INTRAMEDULLARY AVF FORAMNEG MAGNUM DAF PARA-SPINAL AVM
- 7. ASA
- 11. Final diagnosis Intracranial DAVF fed by meningohypophyseal trunk and MMA with spinal perimedullary venous drainage.
- 12. Treatment option: Occlusion of fistula with liquid embolic agent(Onyx).
- 13. References: Doppman J L, G Di Chiro and E H Oldfield. “Origin of spinal arteriovenous malformation and normal cord vasculature from a common segmental artery: angiographic and therapeutic considerations..” Radiology 154, no. 3 (March 1985): 687-689 Minami S, T Sagoh, K Nishimura et al. “Spinal arteriovenous malformation: MR imaging..” Radiology 169, no. 1 (October 1988): 109- 115. doi:VL - 169. Mullan S. Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae. J Neurosurg. 1994;80:606–616.[PubMed] Teng MM, Chang T, Lirng JF et-al. Spinal dural arteriovenous anomalies. J Vasc Interv Radiol. 1992;3 (2): 329-36
- 14. Thank you!