Cervical Spinal dural arteriovenous fistula with rapidly progressive brainstem dysfunction due to venous congestion: A case report

Tatsuya Sasaki, Hiroaki Manabe, Takao Yasuhara, Yasuyuki Miyoshi, Kenji Sugiu, Isao Date

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Spinal dural arteriovenous fistulas (S-dAVFs) are rare vascular malformations of the spine. We experienced a case that presented with rapidly progressive brainstem dysfunction due to venous congestion of cervical dAVFs. A 56-year-old man diagnosed with cervical dAVF four years prior presented with gait disturbance and abnormal thermal nociception on his right side. In addition to the high-intensity lesion from the lower pons to the medulla oblongata on T2-weighted magnetic resonance imaging, diffusion-weighted imaging demonstrated cerebral infarction of the left ventrolateral medulla oblongata. Left vertebral angiography revealed that a feeding artery supplied by the radicular artery at the C4 level formed a fistula with the dilated ascending anterior perimedullary vein. We made a diagnosis of venous congestion due to cervical dAVFs. Numbness on the left upper limb occurred five days after the first symptom. Subsequently, hemiparesis on the left upper limb and swallowing disturbance occurred two weeks after the first symptom. The patient underwent surgical ligation of the dilated abnormal vein, with gradual improvement of his symptoms. Myelopathy due to venous congestion of S-dAVFs usually progresses slowly for several years. However, this case report warns about the possibility that some cases of S-dAVF with rapidly exacerbated symptoms may require prompt therapy.

Original languageEnglish
Pages (from-to)51-56
Number of pages6
JournalNeurological Surgery
Volume43
Issue number1
Publication statusPublished - Jan 1 2015

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Central Nervous System Vascular Malformations
Hyperemia
Brain Stem
Medulla Oblongata
Upper Extremity
Veins
Arteries
Vascular Malformations
Diffusion Magnetic Resonance Imaging
Nociception
Pons
Hypesthesia
Spinal Cord Diseases
Cerebral Infarction
Paresis
Deglutition
Gait
Fistula
Ligation
Angiography

Keywords

  • Brainstem dysfunction
  • Cerebral infarct
  • Myelopathy
  • Spinal dural arteriovenous fistula
  • Venous congestion

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

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abstract = "Spinal dural arteriovenous fistulas (S-dAVFs) are rare vascular malformations of the spine. We experienced a case that presented with rapidly progressive brainstem dysfunction due to venous congestion of cervical dAVFs. A 56-year-old man diagnosed with cervical dAVF four years prior presented with gait disturbance and abnormal thermal nociception on his right side. In addition to the high-intensity lesion from the lower pons to the medulla oblongata on T2-weighted magnetic resonance imaging, diffusion-weighted imaging demonstrated cerebral infarction of the left ventrolateral medulla oblongata. Left vertebral angiography revealed that a feeding artery supplied by the radicular artery at the C4 level formed a fistula with the dilated ascending anterior perimedullary vein. We made a diagnosis of venous congestion due to cervical dAVFs. Numbness on the left upper limb occurred five days after the first symptom. Subsequently, hemiparesis on the left upper limb and swallowing disturbance occurred two weeks after the first symptom. The patient underwent surgical ligation of the dilated abnormal vein, with gradual improvement of his symptoms. Myelopathy due to venous congestion of S-dAVFs usually progresses slowly for several years. However, this case report warns about the possibility that some cases of S-dAVF with rapidly exacerbated symptoms may require prompt therapy.",
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AU - Manabe, Hiroaki

AU - Yasuhara, Takao

AU - Miyoshi, Yasuyuki

AU - Sugiu, Kenji

AU - Date, Isao

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