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April 09, 2019; 92 (15) Resident & Fellow Section

Teaching NeuroImages: Lower cervical spine dural arteriovenous fistula presenting as subarachnoid hemorrhage

View ORCID ProfilePeng Gao, View ORCID ProfileShiwei Du, View ORCID ProfileJian Ren, View ORCID ProfileGuilin Li, View ORCID ProfileHongqi Zhang
First published April 8, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007277
Peng Gao
From the Departments of Interventional Neuroradiology (P.G.) and Neurosurgery (S.D., J.R., G.L., H.Z.), Xuanwu Hospital, Capital Medical University, Beijing, China.
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  • ORCID record for Peng Gao
Shiwei Du
From the Departments of Interventional Neuroradiology (P.G.) and Neurosurgery (S.D., J.R., G.L., H.Z.), Xuanwu Hospital, Capital Medical University, Beijing, China.
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Jian Ren
From the Departments of Interventional Neuroradiology (P.G.) and Neurosurgery (S.D., J.R., G.L., H.Z.), Xuanwu Hospital, Capital Medical University, Beijing, China.
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Guilin Li
From the Departments of Interventional Neuroradiology (P.G.) and Neurosurgery (S.D., J.R., G.L., H.Z.), Xuanwu Hospital, Capital Medical University, Beijing, China.
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Hongqi Zhang
From the Departments of Interventional Neuroradiology (P.G.) and Neurosurgery (S.D., J.R., G.L., H.Z.), Xuanwu Hospital, Capital Medical University, Beijing, China.
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Teaching NeuroImages: Lower cervical spine dural arteriovenous fistula presenting as subarachnoid hemorrhage
Peng Gao, Shiwei Du, Jian Ren, Guilin Li, Hongqi Zhang
Neurology Apr 2019, 92 (15) e1798-e1800; DOI: 10.1212/WNL.0000000000007277

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A 39-year-old man presented with sudden neck pain and headache. CT showed subarachnoid hemorrhage around medulla oblongata. Diagnostic angiography demonstrated a rare spinal dural arteriovenous fistula at the level of C5. The fistula recruits additional spinal pial arteries from the anterior spinal artery as feeding artery, most likely due to the venous sump effect induced by the dural shunt.1 A spinal pial aneurysm, potential cause of hemorrhage, was presumed to be related to the hemodynamic stress produced by the high flow through the shunt (figure 1).2 Endovascular embolization of the aneurysm and surgical interruption of the fistula was performed successfully (figure 2).

Figure 1
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Figure 1 CT, angiography, and illustration

(A) Subarachnoid hemorrhage on CT (black arrowhead).Anterior (B) and lateral view (C), angiography of right thyrocervical trunk. (D) Angiography of left vertebral artery. (E) Superselective angiography of anterior radiculo-medullary artery. (F) Control angiography after aneurysm embolization. (G) Schematic illustration. Illustration by author Jian Ren, MD.

Figure 2
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Figure 2 Intraoperative findings, illustration, and surgical orientation

(A, B) Intraoperative findings. (C) Illustration. (D) Surgical orientation. Illustration by author Jian Ren, MD.

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No targeted funding reported.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

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  • Go to Neurology.org/N for full disclosures.

  • Teaching slides links.lww.com/WNL/A853

  • © 2019 American Academy of Neurology

References

  1. 1.↵
    1. Kim DJ,
    2. Willinsky R,
    3. Geibprasert S, et al
    . Angiographic characteristics and treatment of cervical spinal dural arteriovenous shunts. AJNR Am J Neuroradiol 2010;31:1512–1515.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Lucas JW,
    2. Jones J,
    3. Farin A,
    4. Kim P,
    5. Giannotta SL
    . Cervical spine dural arteriovenous fistula with coexisting spinal radiculopial artery aneurysm presenting as subarachnoid hemorrhage: case report. Neurosurgery 2012;70:E259–E263.
    OpenUrlPubMed

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