Dural Arteriovenous Fistula at the Foramen Magnum with Holocord Myelopathy: Case Report / 신경중재치료의학

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.