Clinical Review & Education
Images in Neurology
Paraparesis From Upper Cervical Spinal Dural Arteriovenous Fistula Anita Tipirneni, MD; Diogo C. Haussen, MD; Jacques J. Morcos, MD; Dileep R. Yavagal, MD
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
Figure 1. Magnetic Resonance Imaging and Angiography A
B
C
D
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.
Figure 2. Intraoperative Images A
B
3
1 2
1
3
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. jamaneurology.com
(Reprinted) JAMA Neurology Published online June 8, 2015
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archneur.jamanetwork.com/ by a University of California - San Diego User on 06/09/2015
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Clinical Review & Education Images in Neurology
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 ARTICLE INFORMATION Author Affiliations: Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida (Tipirneni, Haussen, Yavagal); Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida (Morcos). Corresponding Author: Dileep R. Yavagal, MD, Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th St, 13th Floor, Miami, FL 33136 ([email protected]).
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(Figure 1D) demonstrated resolution of dilated vessels and the patient showed improved motor strength and incontinence. Upper cervical sDVAFs make up only 2% of sDAVFs 1 and can present with lower-level cord symptoms.
Published Online: June 8, 2015. doi:10.1001/jamaneurol.2015.0864. Conflict of Interest Disclosures: Dr Yavagal has worked as a consultant and received consulting fees from Aldegen/Cytomedix Inc, EV3 Neurovascular/Covidien, and Stryker Neurovascular. No other disclosures were reported. Additional Contributions: We thank Roberto Suazo, BFA, Department of Neurological Surgery,
University of Miami Miller School of Medicine, Miami, Florida, for help in imaging composition. He received no financial compensation. REFERENCE 1. Reinges MH, Thron A, Mull M, Huffmann BC, Gilsbach JM. Dural arteriovenous fistulae at the foramen magnum. J Neurol. 2001;248(3):197-203.
JAMA Neurology Published online June 8, 2015 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archneur.jamanetwork.com/ by a University of California - San Diego User on 06/09/2015
jamaneurology.com
Images in Neurology
Paraparesis From Upper Cervical Spinal Dural Arteriovenous Fistula Anita Tipirneni, MD; Diogo C. Haussen, MD; Jacques J. Morcos, MD; Dileep R. Yavagal, MD
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
Figure 1. Magnetic Resonance Imaging and Angiography A
B
C
D
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.
Figure 2. Intraoperative Images A
B
3
1 2
1
3
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. jamaneurology.com
(Reprinted) JAMA Neurology Published online June 8, 2015
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archneur.jamanetwork.com/ by a University of California - San Diego User on 06/09/2015
E1
Clinical Review & Education Images in Neurology
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 ARTICLE INFORMATION Author Affiliations: Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida (Tipirneni, Haussen, Yavagal); Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida (Morcos). Corresponding Author: Dileep R. Yavagal, MD, Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th St, 13th Floor, Miami, FL 33136 ([email protected]).
E2
(Figure 1D) demonstrated resolution of dilated vessels and the patient showed improved motor strength and incontinence. Upper cervical sDVAFs make up only 2% of sDAVFs 1 and can present with lower-level cord symptoms.
Published Online: June 8, 2015. doi:10.1001/jamaneurol.2015.0864. Conflict of Interest Disclosures: Dr Yavagal has worked as a consultant and received consulting fees from Aldegen/Cytomedix Inc, EV3 Neurovascular/Covidien, and Stryker Neurovascular. No other disclosures were reported. Additional Contributions: We thank Roberto Suazo, BFA, Department of Neurological Surgery,
University of Miami Miller School of Medicine, Miami, Florida, for help in imaging composition. He received no financial compensation. REFERENCE 1. Reinges MH, Thron A, Mull M, Huffmann BC, Gilsbach JM. Dural arteriovenous fistulae at the foramen magnum. J Neurol. 2001;248(3):197-203.
JAMA Neurology Published online June 8, 2015 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archneur.jamanetwork.com/ by a University of California - San Diego User on 06/09/2015
jamaneurology.com
