Medcyclopaedia Home E-learningLibraryLexical IndexLexical TopicsGlossaryFace-a-CaseSpinal CordAcute disseminated encephalomyelitis (ADEM)Acute ischemic lesionAstrocytoma, case 1Astrocytoma, case 2Astrocytoma, case 3Astrocytoma, case 4Astrocytoma, case 5Astrocytoma, case 6Astrocytoma grade IIAstrocytoma, surgeryAVM, case 1AVM, case 2AVM, dural fistulaeCavernoma, case 1Cavernoma, case 2Cavernoma, case 3Cavernoma, case 4Cavernous angiomaDural fistula, case 1Dural fistula, case 2Dural fistula, case 3Ependymoma, case 1Ependymoma, case 2Ependymoma, case 3Ependymoma, case 4Ependymoma, case 5Ependymoma grade II, case 1Ependymoma grade II, case 2Ependymoma grade II, case 3Ependymoma grade II, case 4Ependymoma grade II, case 5Ependymoma grade II, case 6Ependymoma grade II, case 7Ependymoma grade II, case 8Ependymoma grade II, case 2Ependymoma grade II, case 10Epidermoid cyst, spinalGangliogliomaGlioblastoma grade IVHemangioblastoma, case 1Hemangioblastoma, case 2Hemangioblastoma, case 3Hemangioblastoma, case 4Hemangioblastoma, case 5Hemangioblastoma, surgeryHerpes myelitisHydatid cyst, spinal cordHydrosyringomyelia, case 1Hydrosyringomyelia, case 2Hydrosyringomyelia, case 3Hydrosyringomyelia, case 4Intramedullary- inflammatory lesionIntramedullary metastasisIschemic lesion in systemic lupus erythematosusLipoma, case 2LymphomaMetastasis, case 1Metastasis, case 2Metastasis, case 3Metastasis, case 4Multiple sclerosis, case 1Multiple sclerosis, case 2Multiple sclerosis, case 3Multiple sclerosis, case 4Multiple sclerosis, case 5Multiple sclerosis, case 6Multiple sclerosis, case 7Myxopapillary ependymoma grade I (WHO)Myxopapillary ependymoma of the conus, case 1Myxopapillary ependymoma of the conus, case 2Myxopapillary ependymomaof the conus, case 1Neurofibromatosis type IIOptic neuritis, Devic's syndrome in disseminated lupus erythematosus (SLE)Paraneoplastic encephalomyelitisPost-vaccination myelitisSarcoidosis, case 1Sarcoidosis, case 2SchwannomaSpinal cord schistosomiasisSpinal cord tuberculosisSubependymal ependymomaTancytic ependymoma grade II, case 1Tanycytic ependymoma grade II, case 2Tanycytic ependymoma grade II, case 3Transverse myelitis of unknown etiologyCerebral TumorsMR Neuro AngiographyTextbook of RadiologyTextbook of Radiology (e-paper)Medical Imaging Made EasyDownloadsMedcyclOasisAbout MedcyclopaediaContact Us
MedcycloPoll
Did you get the help you required from Medcyclopaedia™ during today's visit?
Yes
 
 (84.5%)
No
 
 (10.9%)
Undecided
 
 (4.6%)
You must be logged on to vote.
Please log in or register.
 
 
 

Dural fistula, case 2

 

Clinical history
This 33-year-old male patient presented with gait disturbances as well as urinary and fecal disturbances. He experienced erection problems

Neurological examination
Neurological examination showed no sensory deficit. Minor asymmetry of knee and ankle reflexes.

MRI findings
Image 1: Sagittal T1WI. Mild cord enlargement at the lower thoracic level without clear signal abnormalities
Image 2: Sagittal T2WI. Two hyperintense areas (arrows) are well seen on this pulse sequence in the lower thoracic cord and conus medullaris.
Image 3: Sagittal GdT1WI. Moderate but definite contrast enhancement after Gadolinium injection is seen within the conus (arrow). Prominent vessels are seen on the posterior surface of the cord showing some enhancement as well (arrowheads).
Image 4: Myelo-MRI show definite abnormal tortuous vessels (arrows) suggesting a dural fistula. a. MIP (Maximal Intensity Projection) of a coronal 2D heavily T2 weighted acquisition. b. MIP of a coronal 3D acquisition and c. Sagittal MIP.
Images 5 - 6 - 7 - 8: Spinal Angiography (Courtesy Dr. Georges Rodesch).
Selective spinal angiogram was performed which confirmed the diagnosis of dural fistula with perimedullary venous drainage.
The artery of Adamckiewicz (arrows) was supplied by the right TH 9 posterior intercostal artery (image 5). Capillaro-venous stagnation of contrast medium was observed after selective injection of the artery of Adamckiewicz. Those findings confirmed the increased venous pressure. The vascular malformation was fed by a radiculo-dural branch of the right TH11 intercostal artery (arrow) (image 6). The AV malformation was located at the level of the dura. Venous drainage (image7) (arrows) was provided by the TH11 radicular vein which was connected with the peri-medullary venous plexus. Venous hypertension around the conus was clearly shown on angiography.
The lesion was embolized after selective catheterization of the feeding artery (image 8).

Clinical evolution
Immediate improvement of the patient's condition was observed after embolisation. Control selective medullary angiography confirmed successful embolization (image 9).

Search also:
- AVM, Dural fistulae

 

The ESNR CD-Rom Series

To view high resolution images,
please register first.

Click  here to register.

Already registered? Enter your e-mail in the window below.
Re-register

Fig. 1

Dural fistula, case 2, Fig. 1
Dural fistula, case 2, Fig. 2
Dural fistula, case 2, Fig. 3
Dural fistula, case 2, Fig. 4
Dural fistula, case 2, Fig. 5
Dural fistula, case 2, Fig. 6
Dural fistula, case 2, Fig. 7
Dural fistula, case 2, Fig. 8
Dural fistula, case 2, Fig. 9