Abstract
Intracranial dural arteriovenous fistula presenting with progressive myelopathy is uncommon and such cases have been rarely reported in the literature. It is also difficult to accurately diagnose intracranial fistula in such cases, because the patient only demonstrates symptoms of myelopathy. We recently experienced such a rare case. A 61-year-old man presented with repeated episodes of ameliorable weakness in both lower limbs for a few days. At the same time numbness of both hands, dysuria and constipation occurred. Three months before presentation, motor weakness of both lower limbs again occurred associated with a progressive gait disturbance. As a result, he was referred to our hospital under a diagnosis of a spinal vascular malformation. After performing MRI, 3D-MRA and angiography, a dural arterovenous fistula of the transverse-sigmoid junction was demonstrated, which drained into the spinal cord vein via the superior petrosal sinus and perimedullary vein associated with venous hypertension. Transvenous embolization to the superior petrosal sinus was therefore performed to prevent a backflow into the spinal cord vein. After embolization, the patient's symptoms improved. The mechanism of myelopathy in this case was considered to be vasogenic edema of the spinal cord due to venous hypertension. We stress the importance of making an early diagnosis of this pathology in order to administer the optimal treatment in a timely manner. In addition, the use of 3D-MRA in diagnosing such cases was found to be extremely valuable.
