Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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November 25, 2013
Epidural Arteriovenous Fistula with Perimedullary Drainage
- Rare type of spinal dural arteriovenous fistula
- The clinical findings are related to myelopathy from cord edema caused by insufficient perimedullary drainage/venous congestion.
- Key Diagnostic Features: Prominent vessels on the surface of the cord are seen. Cord edema from venous congestion is seen. Hypointense signal is seen along the peripheral aspect of the cord and reflects slow flow of blood containing deoxyHb within a distended spinal cord capillary and venous system. In our case, selective angiography gives definitive diagnosis and shows communication between radicular artery and perimedullary vein via epidural plexus. The opacification of the plexus gives the clue to the diagnosis, and differentiates it from the more frequent dural arteriovenous fistula.
- DDx: Other types of spinal vascular malformations
- Rx: Endovascular treatment. Surgery is also an option.
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