Inoue Tomoo, Takahashi Toshiyuki, Shimizu Hiroaki, Matsumoto Yasushi, Takahashi Akira, Tominaga Teiji
Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan.
Neurol Med Chir (Tokyo). 2006 Nov;46(11):559-62. doi: 10.2176/nmc.46.559.
A 22-year-old woman presented with a cervical perimedullary arteriovenous fistula (AVF) manifesting as right upper and lower extremity weakness. T2-weighted magnetic resonance (MR) imaging showed intramedullary hyperintensity believed to be caused by venous congestion. Preoperative diffusion-weighted MR imaging showed increased apparent diffusion coefficient (ADC) value. Spinal angiography demonstrated an AVF fed mainly by the right C-5 radicular artery. Complete obliteration of AVF was achieved by endovascular embolization and microsurgical shunt occlusion. The ADC value was normalized and her neurological deficits improved after endovascular surgery, whereas T2-weighted MR imaging still demonstrated the lesion. The high preoperative ADC value probably indicated reversible vasogenic edema and immediate normalization of the ADC value suggests a good clinical outcome.
一名22岁女性因颈髓周动静脉瘘（AVF）就诊，表现为右上肢和下肢无力。T2加权磁共振（MR）成像显示髓内高信号，认为是由静脉充血引起。术前弥散加权MR成像显示表观扩散系数（ADC）值升高。脊髓血管造影显示AVF主要由右侧C-5神经根动脉供血。通过血管内栓塞和显微手术分流闭塞实现了AVF的完全闭塞。血管内手术后，ADC值恢复正常，她的神经功能缺损得到改善，而T2加权MR成像仍显示病变。术前高ADC值可能提示可逆性血管源性水肿，ADC值立即恢复正常提示临床预后良好。
