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Images in Neurology
June 2013

Dural Arteriovenous Fistula at the Craniocervical Junction Mimicking Acute Brainstem and Spinal Cord Infarction

Author Affiliations

Author Affiliations: Department of Neurology and Neuroscience (Drs Salamon and Fink); and Division of Interventional Neuroradiology, Department of Neurological Surgery (Drs Patsalides, Gobin, and Santillan), New York–Presbyterian Hospital, Weill Cornell Medical Center, New York.

JAMA Neurol. 2013;70(6):796. doi:10.1001/jamaneurol.2013.1946

A 43-year-old right-handed man was admitted to our hospital after he developed an abrupt onset of persistent vomiting and intermittent hiccups that progressed to difficulty swallowing, double vision, inability to walk, and difficulty initiating urination. Findings from the neurologic examination were notable for guttural dysarthria, left hypertropia, and right-beating nystagmus on right horizontal gaze. A right upper motor flattened nasolabial fold and decreased palatal elevation on the left side were present. His tongue protruded to the right. His motor examination revealed the presence of a left arm pronator drift and silent Babinski responses. The patient exhibited a severe truncal ataxia and urinary retention.

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