Intracranial dural arteriovenous fistula showing diffuse MR enhancement of the spinal cord - Case report and review of the literature
Intracranial dural arteriovenous fistula showing diffuse MR enhancement of the spinal cord - Case report and review of the literature
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DOI：
10.1016/s0090-3019(02)00861-3
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发表时间：
2002-09-01
影响因子：
--
通讯作者：
Nose, T
中科院分区：
文献类型：
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作者：
Asakawa, H;Yanaka, K;Nose, T
背景：由颅内硬脑膜动静脉瘘（AVF）引起的颈椎病并不常见。了解这些病变的磁共振成像（MRI）表现是很重要的，因为许多脊髓病患者最初都是通过MRI检查的，错误的诊断可能导致治疗延迟或治疗不当。我们描述了一个罕见的情况下，由于脊髓病颅内硬脑膜AVF显示弥漫性增强的颈脊髓。病例描述一个64岁的男性提出了进行性脊髓病和呼吸功能不全。脑血管造影显示在颅颈交界处有动静脉瘘，经鞘内引流至脊髓髓静脉。MRI显示颅颈交界处周围髓周血管扩张，脊髓肿胀伴高信号改变。增强扫描可见颈髓弥漫性强化。成功地通过传入动脉进行栓塞，然后通过枕下外侧入路显微手术闭塞瘘。结论颅内硬脑膜AVF表现为脊髓弥漫性强化是非常罕见的，这种强化效应可能反映了脊髓的病理变化。MRI不仅对诊断有用，而且对显示颅内硬脑膜AVE患者的病理变化和预测预后也有用。(C)2002年，Elsevier Science Inc.
BACKGROUND Cervical myelopathy resulting from intracranial dural arteriovenous fistula (AVF) is uncommon. Knowledge of the magnetic resonance imaging (MRI) appearance of such lesions is important because many patients with myelopathy are initially examined by MRI, and an incorrect diagnosis could result in delayed or improper treatment. We describe a rare case of myelopathy due to an intracranial dural AVF showing diffuse enhancement of the cervical spinal cord.CASE DESCRIPTION A 64-year-old male presented with progressive myelopathy and respiratory insufficiency. Cerebral angiography disclosed an AVF at the craniocervical junction draining intrathecally into the spinal medullary veins. MRI revealed dilated perimedullary vessels around the craniocervical junction, as well as spinal cord swelling with high signal intensity changes. Diffuse intense enhancement of the cervical spinal cord was also seen on postcontrast images. Embolization via the afferent artery was successfully performed, and the fistula was then microsurgically obliterated via a lateral suboccipital approach. This procedure arrested a rapidly progressive myelopathy.CONCLUSION Intracranial dural AVF showing diffuse enhancement of the spinal cord is extremely rare, and this enhancement effect may indicate pathologic changes of the spinal cord. MRI only is not useful for diagnosis, but also for demonstrating pathologic changes and predicting the outcomes of patients with intracranial dural AVE. (C) 2002 by Elsevier Science Inc.