ENHANCED CERVICAL MRI IN IDENTIFYING INTRACRANIAL DURAL ARTERIOVENOUS-FISTULAS WITH SPINAL PERIMEDULLARY VENOUS DRAINAGE

Diagnosis of an intracranial dural arteriovenous fistula (DAVF) with s pinal perimedullary venous drainage is challenging because the present ing symptoms are usually related to dysfunction of the spine, not of t he brain. Repeated spinal angiograms are usually performed before the diagnosis is finally made by cerebral angiography. We report two cases of intracranial DAVFs with spinal perimedullary venous drainage. In b oth cases contrast-enhanced cervical MRI demonstrated dilated lower br ainstem and upper spinal veins, which, we believe, is a good indicator of the existence of such drainage. We suggest that, in cases with per imedullary serpentine enhancement on thoracic or lumbar MR images, add itional Gd-enhanced cervical spinal MR imaging should be performed. Th e simple process of tracing the Veins upwards may avoid a lot of unnec essary examinations and delay in the diagnosis.