Lessons to Be Remembered from a Dural Arteriovenous Fistula Mimicking Medulla and High Cervical Cord Glioma

Bernard, Florian; Lemée, Jean‐Michel; Faguer, R.; Fournier, Henri-Dominique

doi:10.1016/j.wneu.2018.02.161

Cited by 8 publications

(18 citation statements)

References 23 publications

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“…The precise diagnosis of the brain stem and cervical cord lesions is often difficult in the field of neurosurgery. [ 2 , 4 , 6 ] In particular, vascular disease in this area, for example, DAVF, is even more difficult to diagnose accurately, and appropriate therapeutic interventions often tend to be delayed. [ 1 , 2 , 8 , 10 ] Thus, we should take utmost care when treating pathological lesions in this part.…”

Section: Discussionmentioning

confidence: 99%

“…It is commonly accepted that a hyperintense sign-on T2-WI or FLAIR and T1 contrast enhancement of Gd on MRI of the brain stem and cervical cord is mainly related to malignant gliomas. [ 2 , 6 , 8 ] However, for a pathological condition in this area, in particular the medulla oblongata, it is challenging to perform a surgical biopsy for an accurate diagnosis. Thus, this pathological condition could be misdiagnosed as a malignant glioma based on MRI findings alone, and chemoradiotherapy could easily be administered incorrectly.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate diagnosis of the brain stem or cervical spinal cord lesions is very difficult on routine magnetic resonance imaging (MRI). [ 2 , 4 , 6 ] The reason why is that, in this region, various pathological conditions present, for example, tumors (gliomas, lymphoma, and so on), inflammatory diseases, degenerative disorders, vascular diseases, and processes secondary to systemic conditions, and there are no specific findings on MRI to differentiate them. [ 2 , 4 , 6 ] In addition, faster and more accurate diagnosis of pathology is required than for other parts of the body due to the severity of symptoms, and an inadequate diagnosis can lead to an immediately life-threatening condition.…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 , 4 , 6 ] The reason why is that, in this region, various pathological conditions present, for example, tumors (gliomas, lymphoma, and so on), inflammatory diseases, degenerative disorders, vascular diseases, and processes secondary to systemic conditions, and there are no specific findings on MRI to differentiate them. [ 2 , 4 , 6 ] In addition, faster and more accurate diagnosis of pathology is required than for other parts of the body due to the severity of symptoms, and an inadequate diagnosis can lead to an immediately life-threatening condition. [ 2 , 6 ] Here, a rare case of spinal dural arteriovenous fistula (DAVF) presenting as a contrast-enhanced lesion with T2 hyperintensity mimicking malignant glioma of the medulla oblongata is presented.…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 , 4 , 6 ] In addition, faster and more accurate diagnosis of pathology is required than for other parts of the body due to the severity of symptoms, and an inadequate diagnosis can lead to an immediately life-threatening condition. [ 2 , 6 ] Here, a rare case of spinal dural arteriovenous fistula (DAVF) presenting as a contrast-enhanced lesion with T2 hyperintensity mimicking malignant glioma of the medulla oblongata is presented.…”

Section: Introductionmentioning

confidence: 99%

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A rare case of spinal dural arteriovenous fistula mimicking malignant glioma of the medulla oblongata: Significance of cerebral angiography for accurate diagnosis of brain stem region

Shigekawa

Inoue

Nakamura

et al. 2020

Surgical Neurology International

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Background: The findings of a hyperintense sign on T2-weighted imaging (T2-WI) and gadolinium (Gd) contrast enhancement on magnetic resonance imaging (MRI) of the brain stem suggest malignant glioma. However, this pathological condition is probably uncommon, and it may be unknown that a dural arteriovenous fistula (DAVF) can imitate this radiological pattern. In addition, it is extremely rare to be caused by a spinal DAVF. Here, a rare case of spinal DAVF that mimicked malignant glioma of the medulla oblongata is presented. Case Description: A 56-year-old woman was admitted with a progressive gait disturbance, vertigo, and dysphasia. MRI showed a hyperintense signal in the medulla oblongata on fluid-attenuated inversion recovery (FLAIR) and moderate contrast enhancement on Gd-enhanced MRI. Interestingly, Gd-enhanced MRI demonstrated abnormal dilated veins around the brain stem and cervical spinal cord. Cerebral angiography showed spinal DAVF at the left C4/C5 vertebral foramen fed by the C5 radicular artery. The fistula drained into spinal perimedullary veins and flowed out retrograde at the cortical vein of the posterior cranial fossa. Therefore, surgical disconnection of the spinal DAVF was performed by a posterior approach. The patient’s postoperative course was uneventful. Cerebral angiography showed complete disappearance of the DAVF, with marked reductions of the hyperintense sign of the medulla oblongata on FLAIR. Conclusion: This important case illustrates MRI findings mimicking brain stem glioma. In cases with the hyperintense sign-on T2-WI associated with contrast enhancement suspicious of brainstem glioma, careful checking for perimedullary abnormal vessels and additional cerebral angiography should be performed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A rare case of spinal dural arteriovenous fistula mimicking malignant glioma of the medulla oblongata: Significance of cerebral angiography for accurate diagnosis of brain stem region

Shigekawa

Inoue

Nakamura

et al. 2020

Surgical Neurology International

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Watch brain circulation in unexplained progressive myelopathy: a review of Cognard type V arterio-venous fistulas

et al. 2023

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Background Intracranial dural arterio-venous fistulas are pathological anastomoses between arteries and veins located within dural sheets and whose clinical manifestations depend on location and hemodynamic features. They can sometimes display perimedullary venous drainage (Cognard type V fistulas—CVFs) and present as a progressive myelopathy. Our review aims at describing CVFs’ variety of clinical presentation, investigating a possible association between diagnostic delay and outcome and assessing whether there is a correlation between clinical and/or radiological signs and clinical outcomes. Methods We conducted a systematic search on Pubmed, looking for articles describing patients with CVFs complicated with myelopathy. Results A total of 72 articles for an overall of 100 patients were selected. The mean age was 56.20 ± 14.07, 72% of patients were man, and 58% received an initial misdiagnosis. CVFs showed a progressive onset in 65% of cases, beginning with motor symptoms in 79% of cases. As for the MRI, 81% presented spinal flow voids. The median time from symptoms’ onset to diagnosis was 5 months with longer delays for patients experiencing worse outcomes. Finally, 67.1% of patients showed poor outcomes while the remaining 32.9% obtained a partial-to-full recovery. Conclusions We confirmed CVFs’ broad clinical spectrum of presentation and found that the outcome is not associated with the severity of the clinical picture at onset, but it has a negative correlation with the length of diagnostic delay. We furthermore underlined the importance of cervico-dorsal perimedullary T1/T2 flow voids as a reliable MRI parameter to orient the diagnosis and distinguish CVFs from most of their mimics.

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The external carotid artery as a rare feeder of a spinal dural arteriovenous fistula causing cervical myelopathy: A review of the literature

et al. 2021

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Lessons to Be Remembered from a Dural Arteriovenous Fistula Mimicking Medulla and High Cervical Cord Glioma

Cited by 8 publications

References 23 publications

A rare case of spinal dural arteriovenous fistula mimicking malignant glioma of the medulla oblongata: Significance of cerebral angiography for accurate diagnosis of brain stem region

A rare case of spinal dural arteriovenous fistula mimicking malignant glioma of the medulla oblongata: Significance of cerebral angiography for accurate diagnosis of brain stem region

Watch brain circulation in unexplained progressive myelopathy: a review of Cognard type V arterio-venous fistulas

The external carotid artery as a rare feeder of a spinal dural arteriovenous fistula causing cervical myelopathy: A review of the literature

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