0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Dural Arteriovenous Fistula of the Medulla Initially Mimicking Guillain-Barré Syndrome

Camilla Neergaard Clark, MRCP; Tabish A. Saifee, MRCP; Peter O. Cowley, FRCR; Lionel Ginsberg, PhD, FRCP
Arch Neurol. 2012;69(6):786-787. doi:10.1001/archneurol.2011.2934.
Text Size: A A A
Published online

Extract

A 65-year-old woman who was previously well presented with 2 days of ascending flaccid quadriparesis. This had been preceded by 2 weeks of gastroenteritis, with an episode of urinary incontinence at onset. On admission, she was catheterized for urinary retention. She was areflexic in her lower limbs, and power was markedly reduced proximally (1/5) more than distally (4/5). In the upper limbs, her reflexes were present with reinforcement, with global reduction of power (4/5). Her presentation was felt to be consistent with Guillain-Barré syndrome. However, her weakness and areflexia improved 12 hours after admission, returning to full power with brisk reflexes in the upper limbs, reduced knee jerks, and absent ankle jerks. Her power continued to fluctuate while on the ward. These atypical aspects pointed away from a diagnosis of Guillain-Barré syndrome1 and prompted magnetic resonance imaging of the brain and cervical spine, the results of which showed features consistent with a medullary dural arteriovenous fistula, later confirmed by the results of angiography (Figure).

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure. A, T2-weighted axial magnetic resonance imaging scan of the head of a 65-year-old woman that shows a diffuse symmetrical signal abnormality within the medulla with extension inferiorly into the cervical cord, suggestive of venous congestion. There were a few prominent perimedullary flow voids. B, Catheter angiogram (sagittal plane; contrast injected into the right external carotid artery) confirmed the presence of a dural arteriovenous fistula, the fistulous point being located in the region of the right superior petrosal vein with (presumed) venous occlusions leading to congestion in the perimedullary and upper cervical venous channels. The dural supply was from small and tortuous branches of the middle meningeal artery and the meningohypophyseal trunk. The fistulous point was occluded using endovascular embolization with onyx and subsequently surgically. After an initial postoperative episode of quadriparesis and respiratory muscle weakness, the patient is now undergoing neurorehabilitation.

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

171 Views
1 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();