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A difficult case
Dural arteriovenous fistula of the craniocervical junction
  1. Charalampia Koutsioumpa1,
  2. Dave Ho2,3,
  3. Cory Siegel2,3,
  4. Nirav Patel1,
  5. Stelios Smirnakis1,2,
  6. Viken Babikian2,3
  1. 1Neurology Department, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Neurology Department, VA Boston Healthcare System Jamaica Plain Campus, Boston, Massachusetts, USA
  3. 3Neurology Department, Boston University Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Charalampia Koutsioumpa, Brigham and Women's Hospital, Boston, MA 02115, USA; c_koutsioumpa{at}g.harvard.edu

Abstract

Dural arteriovenous (AV) fistulas of the craniocervical junction can be challenging to diagnose. We describe a 70-year-old man with subacute progressive myelopathy whose MR scan of cervical spine showed serpiginous dorsal vessels, suggesting a dural AV fistula. However, a detailed diagnostic angiogram was normal, prompting additional work-up and a wider differential, which was non-revealing. His symptoms progressed over months, but the evolution of the lesion characteristics on repeat spinal imaging still suggested a dural AV fistula. Repeat angiogram identified an infratentorial dural AV fistula arising from the meningohypophyseal artery. He improved following retrosigmoid craniotomy and clipping. Initial angiography does not always demonstrate a dural AV fistula; if there is clinical and radiographic evolution, repeat angiography might identify a fistula with a rare arterial feeder.

  • myelopathy
  • cerebral blood flow
  • cerebrovascular
  • clinical neurology
  • gait

Data availability statement

No data are available. No new datasets were generated.

https://doi.org/10.1136/pn-2023-003912

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    Data availability statement

    No data are available. No new datasets were generated.

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    Footnotes

    • Contributors CK, DH, SS and VB prepared the original manuscript. CK and DH performed the literature review. CS and NP contributed with image acquisition and manuscript input. All authors contributed to the article and approved the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned. Externally peer reviewed by Robin Howard, London, UK.