Limits...
Intracranial dural arteriovenous fistula draining into spinal perimedullary veins: a rare cause of myelopathy.

Akkoc Y, Atamaz F, Oran I, Durmaz B - J. Korean Med. Sci. (2006)

Bottom Line: A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs.Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord.There was no improvement in clinical condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Bornova-IZMIR, Turkey. yesim.akkoc@ege.edu.tr

ABSTRACT
We report a rare case of progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins. A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs. Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord. Cerebral angiography showed a dural arteriovenous fistula fed by the neuromeningeal branch of the left ascending pharyngeal artery. Occlusion of the fistula could be achieved by embolization after a diagnostic and subsequent therapeutic delay. There was no improvement in clinical condition. For the neurologic outcome of these patients it is important that fistula must be treated before ischemic and gliotic changes become irreversible.

Show MeSH

Related in: MedlinePlus

Selective right external carotid artery angiogram (lateral projection) shows a dural arteriovenous (arrow) fistula fed by the branches of the occipital artery, and draining into the perimedullary veins (arrowheads) around the brainstem and cervical spinal cord.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2722015&req=5

Figure 2: Selective right external carotid artery angiogram (lateral projection) shows a dural arteriovenous (arrow) fistula fed by the branches of the occipital artery, and draining into the perimedullary veins (arrowheads) around the brainstem and cervical spinal cord.

Mentions: A 45-yr-old man presented to our department with the complaints of urinary and fecal incontinence and muscle weakness in the lower limbs. He had been admitted to another hospital two months ago, with occipital headaches, nausea and vomiting. He had developed urinary and fecal incontinence and muscle weakness in the lower limbs during the subsequent days. Craniocervical magnetic resonance imaging (MRI) study had been performed and ischemia or myelitis in the upper cervical cord and lower brainstem was considered. The patient was treated with conservative medications with no clinical benefit. Subsequently, he was referred to our hospital two months later. On admission to our department, he was able to walk with a cane. Upper extremity muscle strength was completely normal, but for the lower extremities it was graded for musculus iliopsoas and musculus quadriceps femoris 3/5 on the left side and 4/5 on the right side. Craniocervical MRI at that time revealed a diffuse pontomedullary lesion, which was hyperintense on T2-weighted images most likely corresponding to edema. Prominent flow voids of perimedullary blood vessels were identified as well (Fig. 1). Cerebral and spinal angiography was scheduled because of the presumable vascular malformation. Angiography showed a DAVF fed by the occipital artery of the left external carotid artery. Interestingly, the venous drainage was toward the perimedullary veins (Fig. 2). The fistula site was catheterized by a commercially available microcatheter and the DAVF was occluded by Histoacryl mixed with iodized oil at a concentration of 25%. Control angiography showed disappearance of the fistula (Fig. 3).


Intracranial dural arteriovenous fistula draining into spinal perimedullary veins: a rare cause of myelopathy.

Akkoc Y, Atamaz F, Oran I, Durmaz B - J. Korean Med. Sci. (2006)

Selective right external carotid artery angiogram (lateral projection) shows a dural arteriovenous (arrow) fistula fed by the branches of the occipital artery, and draining into the perimedullary veins (arrowheads) around the brainstem and cervical spinal cord.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2722015&req=5

Figure 2: Selective right external carotid artery angiogram (lateral projection) shows a dural arteriovenous (arrow) fistula fed by the branches of the occipital artery, and draining into the perimedullary veins (arrowheads) around the brainstem and cervical spinal cord.
Mentions: A 45-yr-old man presented to our department with the complaints of urinary and fecal incontinence and muscle weakness in the lower limbs. He had been admitted to another hospital two months ago, with occipital headaches, nausea and vomiting. He had developed urinary and fecal incontinence and muscle weakness in the lower limbs during the subsequent days. Craniocervical magnetic resonance imaging (MRI) study had been performed and ischemia or myelitis in the upper cervical cord and lower brainstem was considered. The patient was treated with conservative medications with no clinical benefit. Subsequently, he was referred to our hospital two months later. On admission to our department, he was able to walk with a cane. Upper extremity muscle strength was completely normal, but for the lower extremities it was graded for musculus iliopsoas and musculus quadriceps femoris 3/5 on the left side and 4/5 on the right side. Craniocervical MRI at that time revealed a diffuse pontomedullary lesion, which was hyperintense on T2-weighted images most likely corresponding to edema. Prominent flow voids of perimedullary blood vessels were identified as well (Fig. 1). Cerebral and spinal angiography was scheduled because of the presumable vascular malformation. Angiography showed a DAVF fed by the occipital artery of the left external carotid artery. Interestingly, the venous drainage was toward the perimedullary veins (Fig. 2). The fistula site was catheterized by a commercially available microcatheter and the DAVF was occluded by Histoacryl mixed with iodized oil at a concentration of 25%. Control angiography showed disappearance of the fistula (Fig. 3).

Bottom Line: A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs.Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord.There was no improvement in clinical condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Bornova-IZMIR, Turkey. yesim.akkoc@ege.edu.tr

ABSTRACT
We report a rare case of progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins. A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs. Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord. Cerebral angiography showed a dural arteriovenous fistula fed by the neuromeningeal branch of the left ascending pharyngeal artery. Occlusion of the fistula could be achieved by embolization after a diagnostic and subsequent therapeutic delay. There was no improvement in clinical condition. For the neurologic outcome of these patients it is important that fistula must be treated before ischemic and gliotic changes become irreversible.

Show MeSH
Related in: MedlinePlus