A case of dural arteriovenous fistula at the craniocervical junction with intramedullary hemorrhage in the medulla oblongata caused by venous congestion

Abstract

Craniocervical junction dural arteriovenous fistula (CCJ dAVF) has been considered traditionally to be characterized by the development of subarachnoid hemorrhage (SAH). However, CCJ dAVF due to congestion in the brainstem and spinal cord has also been reported in recent years. We report a case of dAVF with intramedullary hemorrhage in the medulla oblongata due to congestion. A 71-year-old man with a history of lumbar disc herniation presented with right thumb dorsiflexion disorder. Lower extremity hyperreflexia was also observed but could not be explained by a lumbar lesion. Lumbar MRI revealed no abnormality, but cervical MRI suggested a medullary lesion, which may have been due to cervical spondylosis. Computed tomography showed hemorrhage on the left dorsal side of the medulla oblongata, and MRI showed high signal intensity at the medulla oblongata on T2WI and hemorrhage on the left dorsal side, with flow void and contrasted palisading structures. We diagnosed the case as CCJ dAVF by angiography and performed a surgical blockade of the outflow vein. Surgery improved his symptoms, and the AV shunt was resolved.