Figure 8.

Two cases of SDAVF.

Patient A (A and B), a 59-year-old male, presented with subacute quadriparesis that progressed to bed-ridden state over 4 months. On admission, his cervical spine MRI showed a typical signal void (arrowhead, A) and enhancing vascular structures (arrow, B) over the ventral surface of the cervical spine. He was diagnosed with SDAVF and was treated with embolization. Meanwhile, patient B (C – H), a 78-year-old male, presented with subacute progressive paraparesis over 18 months. His spinal MRI showed diffuse longitudinally extensive T2 HSI lesions in the thoracic spine without definite signal void (C and D), gadolinium enhancement of the spinal cord (E), and prominently enhanced vascular structures over the dorsal surface of the spinal cord (arrow, F). The spinal angiography of patient B, performed of the thoracic T8 spinal dorsal artery (G), showed a SDAVF and engorged/tortuous medullary veins (H). Note that the findings of conventional spinal MRI in patients with SDAVF can vary widely, therefore clinical suspicions are most important.

A, C, and D = T2-weighted MRI; B, E, and F = T1-weighted MRI with gadolinium enhancement; G and H = spinal angiography.

HSI, high signal intensity; SDAVF, spinal dural arteriovenous fistula; T8, thoracic vertebrae 8.