Ann Rehabil Med.  2011 Oct;35(5):733-737. 10.5535/arm.2011.35.5.733.

Dural Arteriovenous Fistula on the Brain Stem and Upper Cervical Spinal Cord: A Case Report

• Sun HS
• Yun HS
• Song MK
• Han JY
• Choi IS
• Lee SG

• KMID: 2267238
• DOI: http://doi.org/10.5535/arm.2011.35.5.733

Abstract

A 53-year-old man abruptly developed headache and unconsciousness. Brain computed tomography (CT) and CT angiography showed subarachnoid hemorrhage, intraventricular hemorrhage, and multiple tortuous vascular structures on the brain stem and upper cervical spinal cord. Four-vessel angiography displayed intradural ventral arteriovenous fistula, supplied by the left vertebral and occipital arteries. Drainage was via both sigmoid sinus and cervical venous plexus. He had been treated with transarterial coil embolization of the left vertebral artery. Subsequently, he suffered from left hemiplegia and cognitive problem. Brain magnetic resonance (MR) and MR angiography performed 4 weeks later revealed multiple infarctions on the left cerebellum, left upper cervical spinal cord, and both medial thalamus, as well as occlusion of the left vertebral artery with reduction in varix size. After rehabilitative management, his muscle strength and cognitive function improved. We report a very rare case of dural arteriovenous fistula on the brain stem and upper cervical spinal cord.

Keyword

Arteriovenous fistula; Brain stem; Spinal cord

MeSH Terms

Angiography
Arteries
Arteriovenous Fistula
Brain
Brain Stem
Central Nervous System Vascular Malformations
Cerebellum
Colon, Sigmoid
Drainage
Headache
Hemiplegia
Hemorrhage
Humans
Infarction
Magnetic Resonance Spectroscopy
Middle Aged
Muscle Strength
Spinal Cord
Subarachnoid Hemorrhage
Thalamus
Unconsciousness
Varicose Veins
Vertebral Artery

Figure

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  Fig. 1 Brain CT and CT angiography show diffuse subarachnoid hemorrhage, intraventricular hemorrhage with hydrocephalus (A, B), and tortuous vascular structures along anterior aspect of brain stem and upper cervical spinal cord (C).

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  Fig. 2 Cerebral angiography shows dural arteriovenous fistula supplied by the left vertebral and occipital arteries (black arrow) (A, B). Transarterial embolization through the left occipital artery failed (black arrow head) (C). However, the left vertebral artery was super-selected with microwire and microcatheter and was embolized with embolic materials, resulting in partial occlusion (white arrow) (D).

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  Fig. 3 Axial T2-weighted images of Brain MRI show subacute to chronic hemorrhagic infarction involving left cerebellar hemisphere (white arrow), left posterolateral aspect of upper cervical spinal cord (black arrow) (A), and both medial thalamus (black arrow head) (B). Sagittal gadolinium enhanced image shows reduction of tortuous vascular structure (white arrow head) (C). MR angiography shows occlusion of left vertebral artery (white arrow) (D).

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