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Spinal Dural AV Fistula — SCE Neurology MCQ

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HardNeuro-oncologySpinal Dural AV FistulaSCE Neurology

A 55-year-old man presents with back pain, progressive bilateral leg weakness, and bladder dysfunction. MRI spine shows an intradural, extramedullary mass at T11–L1 with a prominent serpentine flow void pattern. Spinal angiography confirms an arteriovenous fistula fed by a radicular artery. What is the most likely diagnosis?

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Correct answer: A — Spinal dural arteriovenous fistula (dAVF)

Spinal dural AV fistula (dAVF) is the most common spinal vascular malformation. It presents with progressive myelopathy (congestive myelopathy) due to arterialization of the spinal venous plexus causing venous hypertension and cord oedema. MRI shows T2 hyperintensity of the cord with prominent serpentine flow voids (dilated perimedullary veins) on the dorsal cord surface. Spinal angiography is the gold standard for diagnosis. Treatment is endovascular embolisation or surgical disconnection of the fistula. A: Meningiomas do not show flow voids. C: Ependymomas are intramedullary. D: Disc prolapse is extradural without flow voids. E: Abscess has infection features.

Reference: ABN Spinal Vascular Malformation Guidelines; EAN Spinal dAVF Guidelines