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Published on: May 19, 2015
Dural Arteriovenous Fistulas: A Characteristic Pattern of Edema and Enhancement of the Medulla on MRI
A Z Copelan1, A Krishnan2, H Marin3
1From the Department of Diagnostic Radiology and Medical Imaging (A.Z.C., A.K., R.S.), Beaumont Health - Royal Oak, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan alexander.copelan@uphs.upenn.edu.
Abstract:
Medullary edema with enhancement is rarely reported at initial MR imaging in intracranial dural arteriovenous fistulas. We report a series of 5 patients with dural arteriovenous fistulas, all of whom demonstrated a characteristic pattern of central medullary edema and medullary enhancement at initial MR imaging. Cognard type V dural arteriovenous fistula, defined by drainage into the perimedullary veins and the veins surrounding the brain stem, is a rare yet well-described pathologic entity. Even more rarely reported, however, is its clinical presentation with predominantly bulbar symptoms and MR imaging findings of central medullary edema with enhancement. This constellation of findings frequently leads to a convoluted clinical picture, prompting work-up for alternative disease processes and delaying diagnosis. Because an expedited diagnosis is critical in preventing poor outcomes, it is paramount to make the referring physician and neuroradiologist more cognizant of this rare-yet-characteristic imaging manifestation of dural arteriovenous fistula.
Insights
Medullary edema and enhancement on MR imaging are rare findings in intracranial dural arteriovenous fistulas. This study highlights these characteristic imaging findings in Cognard type V dAVFs, aiding timely diagnosis.
Area of Science:
- Neuroradiology
- Vascular Neurology
Background:
- Intracranial dural arteriovenous fistulas (dAVFs) are abnormal connections between dura mater arteries and veins.
- Cognard type V dAVFs, characterized by perimedullary venous drainage, are rare and can present with subtle or confusing symptoms.
Observation:
- This study reports on 5 patients with Cognard type V dAVFs.
- All patients exhibited a distinct pattern of central medullary edema and enhancement on initial magnetic resonance (MR) imaging.
Findings:
- Medullary edema with enhancement is an uncommon MR imaging finding in dAVFs.
- This specific imaging pattern was consistently observed in the reported cases of Cognard type V dAVFs.
- The constellation of bulbar symptoms and these MR findings can mimic other neurological conditions, delaying diagnosis.
Implications:
- Increased awareness of this characteristic MR imaging finding is crucial for prompt diagnosis of dAVFs.
- Early diagnosis of dAVFs is essential to prevent potentially poor neurological outcomes.
- This highlights the importance of recognizing rare imaging manifestations for accurate diagnosis and timely intervention.
