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Images in Neurology |

Paraparesis From Upper Cervical Spinal Dural Arteriovenous Fistula

Anita Tipirneni, MD1; Diogo C. Haussen, MD1; Jacques J. Morcos, MD2; Dileep R. Yavagal, MD1
[+] Author Affiliations
1Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
JAMA Neurol. 2015;72(8):936-937. doi:10.1001/jamaneurol.2015.0864.
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A 79-year-old man presented with a 2-month history of falls, urinary retention, and constipation. Examination revealed spastic paraparesis and T3 sensory level. Magnetic resonance imaging (Figure 1A) and angiography (Figure 1B and C) revealed a type I spinal dural arteriovenous fistula (sDAVF) at the left C1 nerve root with feeders from the vertebral artery and caudal drainage through the coronal perispinal venous plexus. Following clip ligation of the sDAVF (Figure 2), magnetic resonance imaging (Figure 1D) demonstrated resolution of dilated vessels and the patient showed improved motor strength and incontinence. Upper cervical sDVAFs make up only 2% of sDAVFs1 and can present with lower-level cord symptoms.

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Figure 1.
Magnetic Resonance Imaging and Angiography

A, Preoperative T2-weighted imaging of the cervical spine. Arrowheads: flow voids. B, Angiography. Arrowhead: feeding artery. C, Reconstructed angiography. Blue arrowhead: feeding artery. White arrowhead: likely location of spinal dural arteriovenous fistula. D, Postoperative T2-weighted imaging of the cervical spine, flow voids resolved.

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Figure 2.
Intraoperative Images

A, 1 indicates radicular artery; 2, C1 nerve root; and 3, arterialized draining veins. B, Postclipping of dural arteriovenous fistula. 1 indicates previously arterialized veins darkened.

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