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• Vol.44 No.3
• CLINICA NEUROL, 44: 171−175, 2004
• Vol.44 No.3 contents

Case Report

A 68-year-old man of dural arteriovenous fistula at the cranio-cervical junction with dysesthesia ascending from his both toes

Hiroshi Kobessho, M.D.¹⁾³⁾, Yoshikazu Uesaka, M.D.¹⁾, Masaki Nishimiya, M.D.²⁾, Kanehiro Hasuo, M.D.²⁾ and Masanari Kunimoto, M.D.¹⁾

¹⁾Department of Neurology, International Medical Center of Japan
²⁾Department of Radiology, International Medical Center of Japan
³⁾Division of Endocrinology/Metabolism, Neurology and Hematology/Oncology, Department of Clinical Molecular Medicine, Kobe University School of Medicine

We reported a 68-year-old man of dural arteriovenous fistula at the cranio-cervical junction with dysesthesia ascending from his both toes. He recognized dysesthesia at his both toes 10 months previously. Thereafter dysesthesia ascended to his girdle which was stronger as far as his girdle and gait disturbance developed. Somatosensory evoked potential (SEP) revealed delayed central conduction time. Cervical MRI showed a swelling of the spinal cord and intramedullary hyperintense lesion from the C2 to C7 level on the T2-weighted image. Moreover flow void behind the mudulla oblongata on the T2-weighted MRI was outstanding. Angiogram through right ascending pharyngeal artery revealed enlarged and tortuous anterior and posterior spinal veins at the early arterial phase. We diagnosed as dural arteriovenous fistula (AVF) and conducted intraarterial embolization. After treatment, the swelling and hyperintense lesion of the cervical spinal cord improved on MRI, and flow void behind medulla oblongata was extinguished. Gait disturbance also improved. We think that the valves of veins in the spinal cord are responsible for the tendency of higher venous pressure in outer circumference, which results in the symptom dominating in the lower extremities. We recommend that dural AVF at the cranio-cervical junction should be considered as a differential diagnosis in case with the similar clinical course to our case.

(CLINICA NEUROL, 44: 171−175, 2004)
key words: cranio-cervical junction, dural arteriovenous fistula, spinal vein, central vein, peripheral vein

(Received: 4-Jul-03)