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Neurointervention > Volume 5(1); 2010 > Article
Neurointervention 2010;5(1):53-57.
DOI: https://doi.org/10.5469/neuroint.2010.5.1.53   
Dural Arteriovenous Fistula at the Foramen Magnum with Holocord Myelopathy: Case Report.
Jong Young Lee, Young Dae Cho, Bae Ju Kwon, Moon Hee Han
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. bjkwon74@gmail.com
Abstract
We report a case of dural arteriovenous fistula at the foramen magnum with a diagnostic delay of 10 months from initial myelopathic symptoms. A 59-year-old male with urinary incontinence and progressive ascending weakness of the extremities was transferred through two other hospitals to our institution with no tentative or established diagnosis. A correct diagnosis was not made until 10 months after initial symptoms: follow-up MR images revealed diffuse edema involving the holocord and lower brain stem, and engorged veins around the spinal cord. Cerebral angiography confirmed a dural arteriovenous fistula drained by perimedullary venous plexus. That fistula was occluded by transarterial embolization using NBCA (n-butyl cyanoacrylate). However, it seemed hard to expect any improvement in the clinical condition of the patient due to considerable diagnostic delay. To avoid missing a chance of treatment for this potentially reversible disease, early diagnosis is mandatory and it requires a high-level suspicion.
Key Words: Dural arteriovenous fistula; Foramen magnum; Perimedullary venous drainage; Myelopathy


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