skip to main content

Dural arteriovenous fistula — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardNeuroimagingDural arteriovenous fistulaSCE Neurology

A 63-year-old develops a slowly progressive spastic paraparesis, urinary urgency and patchy sensory loss. Spinal MRI shows longitudinal cord T2 hyperintensity, prominent perimedullary flow voids and venous enhancement around the lower thoracic cord. What investigation is required to establish and localise the suspected lesion?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Catheter spinal angiography covering the relevant segmental arteries

The best answer is “Catheter spinal angiography covering the relevant segmental arteries”. The combination of progressive myelopathy, cord oedema and serpiginous perimedullary vessels is classic for a spinal dural arteriovenous fistula; selective spinal angiography remains necessary to demonstrate and localise the shunt for treatment. “Repeat non-contrast lumbar MRI as the definitive vascular test” is less appropriate because MRI can suggest the diagnosis but cannot reliably define the arterial feeder and fistulous point “Lumbar puncture for oligoclonal bands before vascular imaging” is less appropriate because CSF may be mildly inflammatory or protein-rich and can mislead, but it does not localise the shunt “CT pulmonary angiography to identify the feeding artery” is less appropriate because pulmonary vascular imaging does not interrogate spinal segmental arteries “Sural-nerve biopsy to demonstrate venous hypertension” is less appropriate because the disorder is a treatable spinal vascular shunt rather than a peripheral neuropathy requiring biopsy

Reference: Spinal dural arteriovenous fistula: a practical review. https://pn.bmj.com/content/18/2/117