Intramedullary gadolinium-DTPA enhancement in a patient with cervical spondylotic myelopathy and an associated vascular lesion. Case report.

Intramedullary enhancement of the cervical spinal cord is rare in chronic compression disease. An accompanying vascular lesion should be considered in such a case. A 59-year-old man presented with severe cervical spondylotic myelopathy. Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) enhanced magnetic resonance imaging showed intramedullary enhancement at the C5-6 level, which was the most severely compressed level. A right ascending cervical arteriogram demonstrated a spinal arteriovenous fistula (AVF) fed mainly by the C-6 radicular artery and draining from the posterior medullary vein. Surgery was performed to decompress the myelopathy and to obliterate the AVF. Postoperative MR imaging with Gd-DTPA enhancement showed immediate and complete disappearance of the previous enhancement. The intramedullary enhancement presumably resulted from the intraparenchymal hemodynamics due to the AVF.