What’s the Diagnosis – Case 86
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Note The following is the same diagnosis in a 79 year old man (case 2) with progressive lower extremity weakness.
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Note The following is one more example of the same diagnosis in a 56 year old man (case 3) with headaches and leg weakness.
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Findings In the first case the spinal cord is normal throughout. In the thoracic spine, there are dilated and tortuous vessels seen along the surface of the cord which show prominent enhancement. In the next two cases, there is a marked enlargement and hyper intensity of the spinal cord with tortuous and prominent vessels of the thoracic cord in the 79 year old man and about the cervical cord in the 57 year old man. In the latter patient, there is additional enhancement of the spinal cord and on pre-contrast imaging high signal T1 vessels are seen about the spinal cord.
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Diagnosis: Dural Arteriovenous Fistula Dural AVF is the most common type of spinal vascular malformation but still a relatively rare process. It is typically seen in middle aged to older men who present with progressive and insidious lower extremity weakness as well as possible back pain and bowel/bladder dysfunction. It represents a true arteriovenous fistula with dilated and tortuous veins seen on the cord surface. The abnormality can present anywhere along the neural axis but frequently presents with high signal and enlargement of the spinal cord. Although the AVF is not necessarily adjacent to the inferior aspect of the cord or conus, this area most commonly will show cord abnormalities. The abnormal signal and enhancement of the cord is thought to be related to venous hypertension and altered flow dynamics leading to congestive edema of the cord. These are typically treated with angiography to localize the arterial supply that most often comes from a dural branch of a radicular vessel and then subsequent occlusion by use of permanent embolic agents.
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Resources Spinal dural arteriovenous fistulas: a review. Marcus J, Schwarz J, Singh IP, Sigounas D, Knopman J, Gobin YP, Patsalides A. Curr Atheroscler Rep. 2013 Jul;15(7):335. The diagnosis of spinal dural arteriovenous fistulas. Donghai W, Ning Y, Peng Z, Shuo X, Xueen L, Peng Z, Bin H, Xingang L. Spine (Phila Pa 1976). 2013 Apr 20;38(9):E546-53
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