Intracranial dural arteriovenous fistula with spinal medullary venous drainage

We report on a 46-year-old patient in whom an intracranial dural arterioven ous (AV) fistula, sup; plied by a branch of the ascending pharyngeal artery , drained into spinal veins and produced rapidly progressive symptoms of my elopathy and brainstem dysfunction including respiratory insufficiency. Mag netic resonance imaging studies demonstrated brainstem oedema and dilated v eins of the brainstem and spinal cord. Endovascular embolization of the fis tula led to good neurological recovery, although the patient had been parap legic for 24 h prior to embolization. This case demonstrates the MRI charac teristics of an intracranial dural AV fistula with spinal drainage and illu strates the importance of early diagnosis and treatment. Even paraplegia ma y be reversible, if angiography is performed and the fistula treated before ischaemic and gliotic changes become irreversible.