Dural arteriovenous fistula with venous hypertension and cord edema

Findings

MRI Cervical Spine: Cord expansion involving the majority of the cervical and upper thoracic spinal cord. Abnormal increased T2-STIR signal, extending from the brainstem to the lowest portions of the visualized field-of-view in the upper thoracic cord. Prominent intradural flow-voids seen posteriorly throughout the cervical and upper thoracic cord. Spinal Angiogram: Spinal dural arteriovenous fistula arising from the left T5 radicular artery. Dilated medullary veins drain both cephalad and caudal.

Differential Diagnosis (for MRI findings):
- Normal CSF pulsations
- Spinal cord tumor
- Tortuous roots from spinal stenosis
- Spinal dural AV fistula


Diagnosis: Dural arteriovenous fistula with venous hypertension and cord edema


Key points

Presents with progressive lower extremity weakness, back pain, bowel/bladder dysfunction.
Results in spinal cord ischemia.
Progressive over many years, may lead to paraplegia.
Presents during 50 to 60 years of age.
Male more common than female.
Lesions are AV fistulas, draining into venous outflow tract.
Treatment is surgical obliteration or endovascular embolization.


Radiographic Overview

MRI:
- Enlarged, T2 hyper intense spinal cord
- Edema may spare periphery
- Abnormal vascular flow voids of dilated intradural veins

MRA/Angiogram:
- Confirms diagnosis, allows identification of exact level of shunt, localizes anterior spinal artery