Intracranial Dural Arteriovenous Fistula with Perimedullary Venous Drainage: A Case Report

Intracranial dural arteriovenous fistulas with perimedullary venous drainage are indeed very rare cerebral vascular malformations. They can present with symptoms such as rapidly progressive ascending myelopathy associated with dysautonomia, complicating the diagnostic process and delaying therapeutic intervention. We present the case of a 26-year-old patient admitted to the neurosurgical department for an evolving medullary syndrome caused by an intracranial dural fistula with perimedullary venous drainage. The diagnosis was suspected on a cerebro-medullary MRI, which visualized an arteriovenous shunt at the level of the left superior petrosal sinus and at the level of the ipsilateral internal cerebral vein. The MRI also showed signs of edematous distress of the pontine and tiered medullary regions.