Wiesmann M, Padovan C S, Pfister H W, Yousry T A
Department of Neuroradiology, Klinikum Grosshadern, Ludwig-Maximilian University, Munich, Germany.
Eur Radiol. 2000;10(10):1606-9. doi: 10.1007/s003300000382.
We report on a 46-year-old patient in whom an intracranial dural arteriovenous (AV) fistula, supplied by a branch of the ascending pharyngeal artery, drained into spinal veins and produced rapidly progressive symptoms of myelopathy and brainstem dysfunction including respiratory insufficiency. Magnetic resonance imaging studies demonstrated brainstem oedema and dilated veins of the brainstem and spinal cord. Endovascular embolization of the fistula led to good neurological recovery, although the patient had been paraplegic for 24 h prior to embolization. This case demonstrates the MRI characteristics of an intracranial dural AV fistula with spinal drainage and illustrates the importance of early diagnosis and treatment. Even paraplegia may be reversible, if angiography is performed and the fistula treated before ischaemic and gliotic changes become irreversible.
我们报告了一名46岁患者，其颅内硬脑膜动静脉（AV）瘘由咽升动脉的一个分支供血，引流至脊髓静脉，并迅速出现脊髓病和脑干功能障碍的进行性症状，包括呼吸功能不全。磁共振成像研究显示脑干水肿以及脑干和脊髓静脉扩张。尽管患者在栓塞前已截瘫24小时，但瘘管的血管内栓塞导致了良好的神经功能恢复。该病例展示了伴有脊髓引流的颅内硬脑膜AV瘘的MRI特征，并说明了早期诊断和治疗的重要性。如果在缺血和胶质增生性改变变得不可逆之前进行血管造影并治疗瘘管，即使截瘫也可能是可逆的。
