Dural fistula, case 3

Clinical history
This 53-year-old male complained of acute paraparesis, hypoesthesia of both lower extremities and sphincter dysfunction.

MRI findings
Image 1: Sagittal T1WI, shows mild enlargement of the conus medullaris without signal abnormalities. Small hypointense filling defects due to flow phenomena may be seen at the posterior surface of the cord (arrows)(b).
Image 2: Axial T1WI confirm the lower spinal cord expansion.
Image 3: Sagittal T2WI and image 4: Axial T2WI. T2 weighted images show not only enlargement of the lower thoracic spinal cord and conus but also an extensive, ill defined hyperintense area within the lower cord. Note that the numerous foci of high-velocity signal loss are even better seen on the dorsal surface of the cord.
Image 5: Sagittal Gd T1WI and image 6: Axial Gd T1WI: intense contrast uptake is seen within the lower thoracic spinal cord. Some enhancement is also seen within the abnormal vessels.
Images 7 and 8 (MIP): Coronal 3D myelo-MRI images: optimally demonstrate the abnormal, dilated, tortuous vessels highly suggestive of dural fistula. Those findings led to angiography.

Clinical follow-up
His clinical status improved progressively. After a few weeks, the patient could walk again normally. Diminished pain sensation still persisted.
Selective medullary angiography confirms the diagnosis of dural fistula with one single feeding artery originating from the right L1 artery. Selective catheterization and embolization could not been achieved and the patient was therefore eventually surgically cured.

Search also:
- AVM, Dural fistulae

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