[A rare case of high cervical spinal cord dural arteriovenous fistula presenting with intracranial subarachnoid hemorrhage]

Abstract

It is now recognized that spinal dural arteriovenous fistula causes myelopathy, resulting from congestive venous hypertension of the spinal cord. We have recently encountered a rare case of high cervical spinal cord dural arteriovenous fistula which caused intracranial subarachnoid hemorrhage. The patient was a 62-year-old female, who had exhibited an abrupt onset of severe headache and loss of consciousness. Plain head CT scan revealed intracranial subarachnoid hemorrhage. No abnormal vascular lesions were found on the first cerebral angiography. The second angiographical examination demonstrated a spinal arteriovenous malformation at the high cervical region. A dural arteriovenous fistula around the right C2 nerve root was found by surgical intervention. The fistula was recognized between rt. C2 radicular artery and dural sheath of rt. C2 nerve root, draining to the epidural plexus and intradural local medullary vein. No serpentine coronal venous plexus on the dorsal aspect of the cervical cord was seen as it is in a usual dural type of spinal arteriovenous fistula. The bleeding point was an intradural varix of the medullary vein just where it penetrated the nerve root area. Feeder ligation of the C2 radicular artery and coating of the varix complex were performed. The postoperative course was uneventful. The patient was discharged from our institute with no neurological deficits.