Intradural venous engorgement of CSF-venous fistula mimics spinal dural arteriovenous fistula on MRI: A novel case report and review of literature

Bala McRae-Posani ¹, Ariana Thakurdyal ², Marcus Konner ¹

⁰Department of Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, USA.

The Neuroradiology Journal +

|

June 13, 2025

View abstract on PubMed

Summary

Spinal intradural vein engorgement on MRI can mimic spinal dural arteriovenous fistulas (sdAVF). A rare case of cerebrospinal fluid-venous fistula (CVF) presented similarly, expanding diagnostic considerations for this imaging finding.

Area Of Science

Neurology
Radiology
Neurosurgery

Background

Spinal intradural vein engorgement on MRI is typically linked to spinal dural arteriovenous fistulas (sdAVF).
Spinal dural arteriovenous fistulas (sdAVF) are abnormal connections between dura mater arteries and spinal veins.

Purpose Of The Study

To report a novel case of cerebrospinal fluid-venous fistula (CVF) mimicking sdAVF on spinal MRI.
To highlight the importance of considering spontaneous cerebrospinal fluid (CSF) leaks in the differential diagnosis of spinal intradural venous engorgement.

Main Methods

Case report of a patient with cognitive impairment and spinal MRI findings.
Review of diagnostic imaging and clinical presentation.
Differential diagnosis considerations for intradural venous engorgement.

Main Results

The patient presented with cognitive impairment and MRI showing marked intradural venous engorgement, resembling sdAVF.
Further investigation revealed a diagnosis of cerebrospinal fluid-venous fistula (CVF), a type of spontaneous spinal CSF leak.
This is the first reported case of CVF presenting with imaging findings similar to sdAVF.

Conclusions

Spinal intradural venous engorgement on MRI can be caused by conditions other than sdAVF.
Cerebrospinal fluid-venous fistula (CVF) should be included in the differential diagnosis for spinal intradural venous engorgement, especially in atypical presentations.
Expanding the differential diagnosis aids in accurate diagnosis and management of patients with spinal venous engorgement.

Keywords:

CSF leaks CSF-Venous fistula SIH spinal MRI spinal dural AV fistula spontaneous intracranial hypotension transvenous embolization