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.