Intracranial dural arteriovenous fistula with perimedullary drainage treated by endovascular embolization.

A 66-year-old woman presenting progressive tetraparesis during the past month. Magnetic resonance (MR) showed nonspecific abnormalities in the cervical spinal cord (Figure 1), which could be related to demyelination, neoplasia or inflammation1. However, these findings, in concomitance with extensive dilated perimedullary vessels, suggested myelopathy secondary to dural arteriovenous fistula (DAVF). Digital angiography identified a Cognard type V intracranial DAVF (Figure 2). After prompt endovascular treatment (Figure 3), complete remission of symptoms was obtained. Despite its intracranial location, type V DAVF presents, by definition, perimedullary venous drainage, which leads to venous congestion, and, consequently, intramedullary edema, progressive myelopathy and chronic hypoxia1,2,3.